Dental Press Jounal of Orthodontics
Dental Press International

v. 17, no. 4

Dental Press Journal of Orthodontics – ISSN 2176-9451

Dental Press J. Orthod.

v. 17, no. 4

July / August

2012


Editorial

"An Orthossaurus in social networks"

David Normando

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"An Orthossaurus in social networks"

Is it worth looking without seeing?

Johann W. von Goethe


I bought my first computer in the early ?90s, when I was a resident of the Orthodontics department at Centrinho, USP. However, although I consider myself at the vanguard, my reception to the WWW network took a little longer. It was partly Bill Gates? fault. He made me believe that this tool would not bring any personal or professional benefits. What a mistake ...

In the compass of Gates, I must confess that for a long time I was blind to the social networks. Prejudice, indeed: Guilty as charged, justified by the lack of time. Until one day an undergraduate student got me to know Orkut. After the first contact, I inferred that I should not fray my precious time line with that trinket, and I settled more-and-more to the principle of Gates. It would be my funeral if it were not this parenthesis I do now: here comes "Facebook" to remove myself from the bed of death. It was when I buried the epidermis of an Orthossaurus odonthorrex which lived in me right in the century of the communication revolution.

This time it was a graduate student. I staged disdain, again; an unfocused look, blurry vision typical of a dinosaur. The prejudice was implicit, something just unacceptable to an educator. After the initial repulsion, I asked him to introduce me to this "face". At the beginning of the presentation it seemed an improved version of Orkut, but after much polishing - by curiosity - I ended up starting a journey full of news.

As anyone who uses social networks, I rediscovered friends who I for long didn?t meet, people who I would never have had the opportunity to be in contact if it was not the creation of this powerful communication tool. I also recognized several renowned orthodontists, hooked by the social network. Professionals for whom I have effusive admiration. If all these people are in it, why would not I, this Mesozoic descendant? Then I broke the shackles of prejudice and my concealment of cyberspace. I left the park.

A little more snooping, I found a tool that could help me with my role as an educator, researcher, editor and clinician. There were the groups, space in which people are added with affinity to a particular theme. A kind of ghetto. In the dive, I realized the gap and created two of them. I already felt, by then, that my reptile skin had been tattooed in the past.

To the first group I gave the nickname of Brazilian Orthodontics, which came to a thousand members in one month, thanks to many friends. Now over 1,500 professionals. This group provides notifications with diverse interests within the specialty, such as disclosures of research and events, discussion of clinical cases and sometimes some personal struggles I have the arduous task of mediating.

I confess, however, that the favorite son is the second group, called pompously Brazilian Dental Research. It is close to 2,000 members and still full of deeply respected researchers, publishers, teachers and students from all states in this (in) finite Brazil. Research publications, editorials, information and interesting discussions of scientific methodology - including Biostatistics ? public contests for professors and scientific events are constantly being released by the group. It was by the network, thanks to Prof. Saul Paiva - UFMG, by who I became aware, for example, of the meeting of the Brazilian Association of Scientific Editors, held in July of this year. One of the best events I attended in the last decade. Is there something more useful?

If today I remember that Jurassic time lived in the transition of my dinosaur dentition, it was to over myself from the prejudice, only in the metaphorical sense, thus, I apologize for those who do not participate in social networks; also for understanding that we live in the era of communication and we cannot, ever, renounce, for images and documents are spread in seconds. Much more is to come. Knowledge is power, and communication generates dissemination of knowledge; so, these events, interwoven, reduce inequalities and increase sociability in the anthropological sense. On the other hand, with so much access to information, we still cannot distance ourselves from the real meaning of reptile prejudice because it is stuck to a stereotype.

I would not like to advocate that every orthodontist should participate in the social network, or to abandon the pachydermal fossilization - never, ever. I?m just reporting this learning as a way of advising those who have not had the courage or sufficient stimulus for searching information on this attractive tool. Those who already know, I invite you to participate in the so interesting created groups and visit the information posted. You will notice that the time spent initially will be returned with interest, just click without having to roar. To paraphrase John Munsell: If content is king, communication is the queen; so, save the Queen.

What´s new in Dentistry

Cytotoxicity of orthodontic materials ? The search for the perfect orthodontic material

Matheus Melo Pithon

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For several years, experimental studies in Orthodontics have attempted to define the mechanical properties of various components of orthodontic appliances to improve bracket and orthodontic cement shear bond strength, reduce friction of wires and brackets, increase force of elastics and achieve several other improvements, However, adverse reactions of the oral soft tissues have raised the interest of researchers in determining the biological effects of these materials, that is, their biocompatibility 

Interview

An interview with Juan Martin Palomo

Lincoln Issamu Nojima

  • -Certificate and Masters - Department of Orthodontics, Case Western Reserve University School of Dental Medicine.
  • -Director of Orthodontics in the Case Western Reserve University School of Dental Medicine.
  • -Director, Craniofacial Imaging Center, Case Western Reserve University School of Dental Medicine.
  • - Visiting Professor, Department of Orthodontics, University of Belgrade, Serbia.
  • - Active member of the American Association or Orthodontists (AAO) and the American Academy of Oral and Maxillofacial Radiology (AAOMR).
  • - Diplomate American Board of Orthodontics.
  • - Member of AAO Committee On Information Technology (COIT).
  • - Member of American Dental Association (ADA) Standards Committee on Dental Informatics [SCDI] Working Groups 12.1- Application of the DICOM Standard in Dentistry and 11.6 - Integration of Orthodontic Standards.
  • - Member of AAO/AAOMR Council on Creating Guidelines for the use of CBCT in Orthodontics.
  • - Guest Editor - Seminar in Orthodontics ? Cone Beam CT for the Orthodontist 2010.
  • - Editorial Review Board - Bone, American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, European Journal of Orthodontics, Journal of Clinical Orthodontics, Journal of the American Dental Association, International Journal of Oral Science, Journal of Applied Oral Science, etc.
  • - American Association of Orthodontists Foundation (AAOF) Awards in 1999, 2001 and 2004.
  • - Past President of the Omnicron Kappa Upsilon (OKU) National Honor Dental Society.


Professor J. Martin Palomo is a graduate of the Ponta Grossa State University and proudly hails from Ponta Grossa, Brazil. He was selected to specialize at the prestigious Case Western Reserve School of Dental Medicine (CWRU) in Cleveland Ohio and during his graduate training, began to feel that he could serve the profession more broadly through academics and specifically through imaging. Dr Palomo?s ambition has always been to serve his native Brazil; he has worked in Curitiba, the mayorship of Manoel Ribas, and the university of UNIPAR, in Umuarama. While working as an orthodontist in Brazil, he was invited to return to CWRU and appointed to Clinic Director and Research Fellow of the Bolton Brush Center. Dr Palomo earned several awards for his teaching from the American Association of Orthodontics and chaired their Council on Education Leadership Implementing Evidence Based Dentistry. Today Dr. Palomo is the Director of Orthodontics and Chair of the Graduate Studies Committee at CWRU. He has built the premier imaging center in the Midwest and is busy authoring the American Dental Association position paper on the subject. He has assembled an award winning team of top notch researchers, clinical orthodontists, physicians, and graduate students who contribute to the profession. His ambition is to serve his native Brazil through authorship, speaking, meetings, and collaborations. Dr. Palomo is married to a periodontist and they have a 7 year-old daughter and three dogs.

Lincoln I. Nojima

Orthodontic Insight

Advancements in the knowledge of induced tooth movement: Idiopathic osteosclerosis, cortical bone and orthodontic movement

Alberto Consolaro, Renata Bianco Consolaro

Cortical bone. Idiopathic osteosclerosis. Chronic focal sclerosing osteitis [osteomyelitis]. Orthodontic movement. Induced tooth movement.

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Moving teeth orthodontically through the dense trabecular bone and cortical areas may require a reduction in the intensity and/or concentration of the applied forces. In part, the orthodontic applied forces are dissipated and reduced by bone deflection, which normally occurs by a slight degree of elasticity of bone tissue in normal conditions. In areas of dense trabecular and in cortical bone this deflection should be insignificant or nonexistent. If there is no reduction in the intensity of the forces in these mentioned regions, the entire force will focus on the structure of the periodontal ligament, increasing the risk of death of cementoblasts, hyalinization and root resorption. Further studies could assess the prevalence of these consequences in populations selected for this purpose, so that would no longer be randomly observed notes.

Online Article

Evaluation of shear bond strength of different treatments of ceramic bracket surfaces

Patrícia Helou Ramos Andrade, Rogério Vieira Reges, Marcos Augusto Lenza

Ceramic bracket. Composite. Shear strength.

Objective: To evaluate the bonding strength of the ceramic bracket and composite resin restoration interface, using four types of treatment on the base of the bracket. 

Methodology: 48 photoactivated composite resin discs were used (Filtek? Z250) contained in specimens and divided into 4 groups of 12 specimens for each group according to the type of treatment performed on the base of the brackets. Once the brackets were bonded, the specimens were subjected to shear stress carried out in a universal testing machine (MTS: 810 Material Test System) calibrated with a fixed speed of 0.5 mm / minute. The values obtained were recorded and compared by means of appropriate statistical tests - analysis of variance and then Tukey?s test. 

Results and conclusions: The surfaces of ceramic brackets conditioned with 10% hydrofluoric acid for 1 minute, followed by aluminum oxide blasting, 50µ, after silane application and primer application, was considered the best method to prepare surfaces of ceramic brackets prior to orthodontic esthetic bonding.

Use of chondroitin sulphate and glucosamine sulphate in degenerative changes in TMJ: A systematic review

Eduardo Machado, Patricia Machado, Paulo Afonso Cunali

Chondroitin. Glucosamine. Temporomandibular joint. Temporomandibular disorder. Osteoarthrosis. Osteoarthritis.

Introduction: Degenerative changes in Temporomandibular Joint (TMJ) have increased in prevalence and severity over the years. Within this context, it?s necessary to obtain safe and effective therapies for control and management of the patient in cases of osteoarthritis and osteoarthrosis of the TMJ. Therapeutic options range from intra-articular infiltration protocols, occlusal splints, pharmacological therapies and physiotherapy and educational measures. The alternative treatment with structure-modifying agents, like as chondroitin and glucosamine sulphates, showed promising results, and especially safety. Thus, through a systematic literature review, this study aimed to analyze and discuss effectiveness and safety of chondroitin and glucosamine in degenerative changes of the TMJ.

Methods: Survey in research bases MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs and BBO, between the years of 1966 and January 2009, with focus in randomized clinical trial (RCTs) and quasi-randomized clinical trials, systematic reviews and meta-analysis. 

Results: After application of the inclusion criteria 2 articles were selected, both randomized controlled double-blind clinical trials, which evaluated the effectiveness of chondroitin and glucosamine in degenerative changes of the TMJ.

Conclusions: There is the necessity of further RCT, with representative samples and long follow-up time, to obtainment more precise cause-effect relationships and to achieve an effective and objective protocol involving chondroitin and glucosamine in cases of degenerative changes of the TMJ.

Use of chondroitin sulphate and glucosamine sulphate in degenerative changes in TMJ: A systematic review

Eduardo Machado, Patricia Machado, Paulo Afonso Cunali

Chondroitin. Glucosamine. Temporomandibular joint. Temporomandibular disorder. Osteoarthrosis. Osteoarthritis.

Introduction: Degenerative changes in Temporomandibular Joint (TMJ) have increased in prevalence and severity over the years. Within this context, it?s necessary to obtain safe and effective therapies for control and management of the patient in cases of osteoarthritis and osteoarthrosis of the TMJ. Therapeutic options range from intra-articular infiltration protocols, occlusal splints, pharmacological therapies and physiotherapy and educational measures. The alternative treatment with structure-modifying agents, like as chondroitin and glucosamine sulphates, showed promising results, and especially safety. Thus, through a systematic literature review, this study aimed to analyze and discuss effectiveness and safety of chondroitin and glucosamine in degenerative changes of the TMJ.

Methods: Survey in research bases MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs and BBO, between the years of 1966 and January 2009, with focus in randomized clinical trial (RCTs) and quasi-randomized clinical trials, systematic reviews and meta-analysis. 

Results: After application of the inclusion criteria 2 articles were selected, both randomized controlled double-blind clinical trials, which evaluated the effectiveness of chondroitin and glucosamine in degenerative changes of the TMJ.

Conclusions: There is the necessity of further RCT, with representative samples and long follow-up time, to obtainment more precise cause-effect relationships and to achieve an effective and objective protocol involving chondroitin and glucosamine in cases of degenerative changes of the TMJ.


Knoop hardness of enamel and shear bond strength of brackets bonded with composite resin with and without fluoride

Silvia Amélia Scudeler Vedovello, Marcelo Grigoletto, Mário Vedovello Filho, Heloísa Cristina Valdrighi, Mayury Kuramae

Composite resins. Orthodontic brackets. Hardness. Shear strength.

Objective: The aim of this study was to evaluate the Knoop hardness of enamel, shear bond strength and failure pattern (adhesive, bracket/resin interface and mixed) after bonding and debonding brackets, using resin composite with fluoride (Ortho Lite Cure, Ortho Source®) and without fluoride (Orthobond, Morelli®). 

Methods: Fragments (6 mm x 6 mm) of 40 bovine incisor crowns were embedded in acrylic self-polymerizing resin. The Knoop hardness measurements were performed before and after bonding metal brackets. The specimens were divided into two groups, according to composite resin: with fluoride (Ortho Lite Cure, Ortho Source®) and without fluoride (Orthobond, Morelli®). After bonding, the specimens were submitted to demineralization and remineralization cycling for 14 days. Shear bond strength testing was performed in a universal test machine (EMIC), at 5 mm/min crosshead speed. 

Results: There was no significant difference in shear bond strength between Groups I and II. After demineralization and remineralization procedures (DE/RE), the specimens bonded with Ortho Lite Cure showed higher Knoop hardness than Orthobond. For both groups there was predominance of failure at bracket/resin interface. 

Conclusion: specimens bonded with fluoride resin composite showed higher microhardness after DE/RE cycling than those bonded with resin composite without fluoride, although no difference in shear bond strength was found.

Assessment of shear bond strength of brackets bonded by direct and indirect techniques: An in vitro study

Roberto Hideo Shimizu , Karlos Giovani Grando, Gilberto Vilanova Queiroz, Augusto Ricardo Andriguetto, Ana Cláudia Moreira Melo, Eduardo Leão Witters

Dental bonding. Dental debonding. Shear bond strength. Corrective orthodontics.

Objective: This in vitro study was designed to evaluate the shear bond strength (SBS) of orthodontic metal brackets bonded by direct and indirect techniques.

Methods: Thirty healthy human maxillary premolar teeth were used. The teeth were divided into three groups of 10 teeth each: Group I ? indirect bonding with Sondhi? Rapid-Set system (3M/Unitek), Group II ? indirect bonding with Transbond? XT adhesive system (3M/Unitek) and Group III ? direct bonding with Transbond? XT adhesive system (3M/Unitek). After bonding and obtaining the specimens for the study, the specimens were subjected to SBS testing in a universal testing machine (Emic, model DL-500). The Kolmogorov-Smirnov test was applied to ascertain that the data had a normal distribution and the Bartlett test to check whether there was homogeneity of variance. One-factor analysis of variance was performed and, subsequently, Tukey?s test for paired means. A 5% significance level was adopted.

Results: The results of Group I were 67.6 (N) and 5.9 (MPa); Group II, 68.9 (N) and 6.1 (MPa) and Group III (control), 92.5 (N) and 8.1 (MPa).

Conclusion: It can therefore be concluded that the means for Group III were significantly higher compared with Groups I and II in both Newton (N) and Megapascal (MPa) values. The means attained by the indirect bonding technique used in Groups I and II, however, exhibited no statistically significant differences.


Maxillary constriction: Are there differences between anterior and posterior regions?

Regina Helena Lourenço Belluzzo, Kurt Faltin Junior, Cícero Ermínio Lascala, Lucas Bacci Renno Vianna

Maxilla. Dental casts. Treatment results.

Objective: To evaluate the transverse constriction of the maxilla in both anterior and posterior regions, using Korkhaus analysis and to check whether there were any statistically significant differences within its values. 

Method: The sample comprised 341 study models. The study models were randomly selected from previous cases, without gender, age and malocclusion restrictions. The models were submitted to Korkhaus analysis. Data from these models were subjected to statistical analyzes in order to evaluate differences in anterior and posterior regions. 

Results: The transverse discrepancies were statistically significant (p<0.001) with a greater constriction in the anterior region (mean -2.84 mm). 

Conclusion: The results showed that the differential diagnosis is very important and the treatment plan may be adapted to specific therapy focusing in a greater expansion in the anterior region.

Orthodontic cements: Immediate protection and fluoride release

Rogério Lacerda dos Santos, Matheus Melo Pithon, Júlia Barbosa Pereira Leonardo, Edna Lúcia Couto Oberosler, Delmo Santiago Vaitsman, Antônio Carlos de Oliveira Ruellas

Glass ionomer cement. Fluoride release. Varnish.

Objectives: The objective of the authors was to evaluate fluoride release of 3 glass ionomer cements with immediate protection of fluoride varnish (Cavitine, SS White), divided into 3 groups: Group M (Meron, VOCO), Group V (Vidrion C, SS White) and Group KC (Ketac-Cem, 3M ESPE). 

Methods: Fluoride release was measured during 60 days by means of an ion-selective electrode connected to an ion analyzer. After 4 weeks, the test specimens were exposed to a solution of 0.221% sodium fluoride (1000 ppm of fluoride). 

Results: Results showed that the cements reached a maximum peak of fluoride release in a period of 24h. There was a statistically significant difference between the amount of fluoride released after the applications of fluoride among the groups from the 31st to 60th day (p> 0.05). 

Conclusion: The Vidrion C and Meron cements showed better performance to uptake and release fluoride when compared with Ketac-Cem cement.


Original Article

Optimization of orthodontic treatment using the Centrex System to retract anterior teeth

José Kleber Soares de Meireles, Weber José da Silva Ursi

Orthodontic anchorage. Dental mini implants. Center of resistance.

Introduction: In the end of 90?s the adoption of mini-implants as Anchorage allowed a paradigm change influencing even the way of thinking orthodontic mechanics. The overlapping of the specialties of Orthodontics and Implantology started with orthodontic preparations for prosthetic implants insertion, aroused with the use of palatal implants and late with the introduction of mini-implants. The improvement of mini-implants insertion technique with the appearing of self-drilling screws has allowed orthodontists to plan and to place this precious Anchorage piece. Taking into account the versatility of positioning of these screws it was developed a concept that allows the construction of force action lines aiming at optimize the planning and predictability of orthodontic motion.

Objective: To present some clinical results treatments conduct using Centrex System of orthodontic treatment, approximating the force line action of resistance center  of units to be moved. The traced way to its development, previously treated in this journal, will be detailed for better understanding of its functioning.


Comparative study of frictional forces generated by NiTi archwire deformation in different orthodontic brackets: In vitro evaluation

Gilberto Vilanova Queiroz, Rafael Yagüe Ballester, João Batista de Paiva, José Rino Neto, Giselle Mara Galon

Orthodontic brackets. Friction. Corrective Orthodontics.

Introduction: The purpose of this study was to compare the frictional forces between 0.014-in NiTi wires (Aditek) with 4 mm horizontal deflection and brackets with different archwire ligation systems.

Methods: Four types of self-ligating brackets (Damon MX, Easy Clip, Smart Clip and In-Ovation), a triple bracket (Synergy) and a twin bracket with 8-shaped ligature (Tecnident) were tested. Twin brackets with conventional elastomeric ligatures (Morelli) were used as control group. Tests were repeated 10 times for each bracket/archwire combination. Frictional forces were measured in an Instron universal tensile machine at 3 mm/minute speed and a total displacement of 6 mm. Statistical analysis comprised ANOVA and Dunnett?s multiple comparison post hoc test.

Results: Deflection-induced frictional (DIF) forces increased in the following order: Synergy, Damon, 8-shaped Ligature, Easy Clip, In-Ovation, Smart-Clip and conventional ligatures. The differences among groups were significant, with the exception of the 8-shaped ligature groups which was equal to the Damon and Easy Clip groups.

Conclusions: Compared to conventional ligatures, all ligation systems tested reduced frictional forces. However, such reduction varied according to the ligation system employed.

Assessment of surface friction of self-ligating brackets under conditions of angulated traction

Roberta Buzzoni, Carlos Nelson Elias , Daniel Jogaib Fernandes, José Augusto Mendes Miguel

Orthodontic brackets. Friction. Stainless steel. Ligation.

Objective: The aim of this study was to assess resistance to sliding of stainless steel passive self-ligating brackets with 0° and 2.5° angulations and to compare them to active self-ligating brackets at zero angulation. The hypothesis to be tested was that passive self-ligating brackets produce lower frictional forces than active self-ligating brackets. 

Methods: Twenty five 0.022 x 0.028-in slot maxillary canine brackets were divided into 5 groups of 5 brackets: Damon SL II (Ormco, CA, USA) self-ligating bracket and Gemini (3M/Unitek, CA, USA) conventional bracket with angulation of 0 and 2.5° and a group of Speed 2 (American Orthodontics, WI, USA) active clip self-ligating system with zero angulation. Twenty five segments of stainless steel 0.020-in archwire (TP Orthodontics, IN, USA) were tested and each bracket/wire interface was evaluated at 4 successive points during sliding. Overall, 100 frictional values were analyzed by parametric analysis of variance and Bonferroni tests. 

Results and Conclusion: Frictional tests were performed with an Emic DL 10000 testing machine (Emic, Brazil) with a load cell of one kilogram. Passive self-ligating brackets produced lower frictional forces than active self-ligating brackets (p < 0.01). Under angulation, brackets with a slide mechanism produced higher friction than the same brackets under zero angulation (p < 0.01). Nevertheless, the slide system under angulation produced smaller friction values than conventional brackets tied with elastomeric ligatures in 0° tests.


Stability of maxillary anterior crowding treatment

Camila Leite Quaglio, Karina Maria Salvatore de Freitas, Marcos Roberto de Freitas, Guilherme Janson , José Fernando Castanha Henriques

Crowding. Angle Class I malocclusion. Angle Class II malocclusion. Corrective Orthodontics.

Objective: To evaluate the stability and the relapse of maxillary anterior crowding treatment on cases with premolar extraction and evaluate the tendency of the teeth to return to their pretreatment position. 

Methods: The experimental sample consisted of 70 patients of both sex with an initial Class I and Class II maloclusion and treated with first premolar extractions. The initial mean age was 13,08 years. Dental casts? measurements were obtained at three stages (pretreatment, posttreatment and posttreatment of 9 years on average) and the variables assessed were Little Irregularity Index, maxillary arch length and intercanine. Pearson correlation coefficient was used to know if some studied variable would have influence on the crowding in the three stages (LII1, LII2, LII3) and in each linear displacement of the Little irregularity index (A, B, C, D, E) in the initial and post-retention phases. 

Results: The maxillary crowding relapse ( LII3-2) is influenced by the initial ( LII1), and the teeth tend to return to their pretreatment position.

Conclusion: The results underline the attention that the orthodontist should be given to the maxillary anterior relapse, primarily on those teeth that are crowded before the treatment.


Maxillary incisors mesiodistal angulation changes in patients with orthodontically treated anterior superior diastemas

Juliana Fernandes de Morais, Marcos Roberto de Freitas, Karina Maria Salvatore de Freitas, Guilherme Janson , Nuria Cabral Castello Branco, Marcelo Zanda

Angulation. Diastema. Stability. Panoramic radiograph. Orthodontics.

Objective: The aims of this study were to describe the patterns of maxillary incisor angulation in patients with upper interincisive diastemas, to evaluate angulation changes with treatment and posttreatment period, and to assess whether there are association between incisor angulation and interincisive diastema relapse. 

Methods: The sample comprised 30 Class I or Class II patients with at least one pretreatment anterior diastema of 0.77 mm or greater after eruption of maxillary permanent canines. Data were obtained from panoramic radiographs at pretreatment, posttreatment and at least 2 years post-retention. 

Results: Incisors presented a mesial tipping tendency after treatment, but only lateral incisors showed significant changes between pre and posttreatment stages. 

Conclusion: Regarding post-retention period, no changes were found. Finally, no relation was found between diastema relapse and maxillary incisor axial angulation.

Microbiological evaluation of bristles of frequently used toothbrushes

Celso André Ferreira, Geovana Dagostim Savi, Ana Paula Panatto, Jaqueline da Silva Generoso, Tatiana Barichello

Introduction: Brushing teeth is probably the practice of oral hygiene most common in the world; however, inadequate use can become a risk to the population health, once they may be contaminated with various microorganisms.

Objective: The aim of this study was to evaluate the bacterial contamination on toothbrush bristles using different methodologies. 

Method: We used 40 toothbrushes from healthy individuals aged 3 to 58 years. The samples were grown in test tubes containing trypticase soy broth sterile, and with the help of a tracking 0.1 ?l samples were placed on plates containing sheep blood agar 5% and MacConkey agar then the samples were stored in a bacteriological incubator at 37°C for 24 hours for later analysis. It was counted the colony forming units and bacteria identification present in the brush. 

Results: On the microbiological analysis, there was a growth of Escherichia coli, Klebsiella pneumoniae, Streptococcus pyogenes and Staphylococcus coagulase negative.

Conclusion: According to the results presented in this study, we observed a high incidence of bacterial contamination in the brushes analyzed. The most frequent microorganisms were members of the Enterobacteriaceae. The usage time of toothbrushes may be related to contamination found and, therefore, not only good hygiene ensures the reduction of microbial load, but replacing the toothbrush can also ensure individuals better oral health.


Evaluation of enamel surface after bracket debonding and polishing

Lilian Maria Brisque Pignatta, Sillas Duarte Júnior, Eduardo César Almada Santos

Introduction: Preserving the dental enamel structure during removal of orthodontic accessories is a clinician?s obligation. Hence the search for an evidence based debonding protocol. 

Objective: to evaluate and compare, by means of scanning electron microscopy (SEM), the effects of four different protocols of bracket debonding and subsequent polishing on enamel surface, and to propose a protocol that minimizes damage to enamel surface. 

Methods: Twelve bovine permanent incisors were divided into four groups according to the instrument used for debonding and removal of the adhesive remnant. In groups 1 and 2, brackets were debonded with a straight debonding plier (Ormco Corp., Glendora, California, USA), and in groups 3 and 4, debonding was performed with the instrument Lift-Off (3M Unitek, Monrovia, California, USA). In groups 1 and 3, the adhesive remnant was removed using a long adhesive removing plier (Ormco Corp., Glendora, California, USA) and in groups 2 and 4, residual adhesive was removed with a tungsten carbide bur (Beavers Dental) at high-speed. After each stage of debonding and polishing, enamel surfaces were replicated and electron micrographs were obtained with 50 and 200X magnification. 

Results: All four protocols of debonding and polishing caused enamel irregularities. 

Conclusion: Debonding brackets with straight debonding plier, removal of adhesive remnant with a tungsten carbide bur and polishing with pumice and rubber cup was found to be the protocol that caused less damage to enamel surface, therefore this protocol is suggested for debonding brackets.

Bracket/wire play: What to expect from tipping prescription on pre-adjusted appliances

Leopoldino Capelozza Filho, Fabricio Monteiro de Castro Machado, Terumi Okada Ozawa, Arlete de Oliveira Cavassan, Maurício Almeida Cardoso

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Introduction: The opinion on the ?straight-wire? concept has been evolving since its origin, characterized by faithful followers or absolute skepticism. Currently, it seems reasonable to state that most professionals have a more realistic and critical viewpoint, with an attitude that reveals Orthodontics? maturity and greater knowledge on the technique. The most relevant criticisms refer to the impossibility of the both the Straight-Wire and the Standard systems to completely express the characteristics related to the brackets due to mechanical deficiencies, such as bracket/wire play. 

Objectives: A critical analysis of this relationship, which is unclear due to lack of studies, was the scope of this paper. 

Methods: The compensatory treatment of two patients, using Capelozza?s individualized brackets, works as the scenery for cephalometric evaluation of changes in incisor inclination produced by different dimensions of leveling archwires. 

Results: The evaluation of these cases showed that, while the introduction of a 0.019 x 0.025-in stainless steel archwire in a 0.022 x 0.030-in slot did not produce significant changes in incisor inclination, the 0.021 x 0.025-in archwire was capable of changing it, mainly in mandibular incisors, and in the opposite direction to the compensation. 

Conclusion: Considering compensatory treatments, even when using an individualized prescription according to the malocclusion, the bracket/wire play seems to be a positive factor for malocclusion correction, without undesirable movements. Therefore, it seems reasonable to admit that, until a bracket system can have absolute individualization, the use of rectangular wires that still have a certain play with the bracket slot is advisable. 


The influence of sucking habits on occlusion development in the first 36 months

Edson Theodoro dos Santos Neto, Adauto Emmerich Oliveira, Rodrigo Walter Barbosa, Eliana Zandonade, Zilda Fagundes Lima Oliveira

Morphogenesis. Dental arch. Sucking behavior. Preventive dentistry.

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Objective: The objective of this study was to identify the influence of sucking habits on the occlusal characteristics of the deciduous dentition.

Methods: The initial sample consisted of 86 infants, aged 0 to 3 months. Seven home visits were performed, when and information on breastfeeding practice, nutritive and non-nutritive sucking habits, mouth breathing and dentition development was collected. From the first sample, impressions of the dental arches were obtained from 58 children at the age of 36 months (+2.51SD). Dental casts were obtained and two examiners, trained and calibrated by the Kappa and Pearson Correlation tests, measured several parameters of dental occlusion, such as arch length, depth, and width. 

Results: The results showed that bottle feeding before 6 months was associated to an increased mandibular intermolar width (p=0.01). Pacifier use before 6 months was statistically associated to a reduction of the maxillary intercanine (p=0.03) and intermolar (p=0.03) width. In addition to these findings, the increased molar depth of the maxillary arch was associated to loss of lip closure before the age of 12 months (p= 0.03).

Conclusion: According to these results, it could be concluded that sucking habits interfere with the determination of some deciduous occlusal characteristics: pacifier sucking limits lateral-lateral maxillary growth, bottle feeding favors lateral-lateral mandibular growth and open bite development, and the lack of lip closure favors the anteroposterior maxillary growth.


Evaluation of disinfection methods of orthodontic pliers

Camilla Machado Feitosa de Almeida, Adriana Silva de Carvalho, Danilo Antônio Duarte

Disinfection. Pliers. Orthodontics. Alcohol. Glutaraldehyde.

Introduction: In recent years, a strong behavior change regarding the control of cross infection during dental treatment was perceived, except among some orthodontists who insist in the misconception that Orthodontics is a specialty of low risk in the transmission of infectious and contagious diseases. 

Objective: The objective of this study was to evaluate the methods used by orthodontists for disinfection of pliers in their daily practice. 

Methods: The bacteria Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus salivarius were inoculated in vitro in 30 orthodontic pliers. The pliers were divided into 3 groups (n = 10) and disinfected in different ways. Group 1: Brush, soap and water; Group 2: Cotton soaked in ethyl alcohol 70%; Group 3: Immersion in a solution of 2% glutaraldehyde for 30 minutes and then rinsed with water. 

Results: The results showed that the ethyl alcohol 70% (Group 2) kept 20% of the pliers infected, being more efficient than the soap and water (Group 1), which maintained 60% of contaminated pliers. Only immersion in 2% glutaraldehyde was able to decontaminate all pliers and was statistically superior to the aforementioned methods (p = 0.030). 

Conclusion: Based on these results, we concluded that among the tested methods, disinfection of orthodontic pliers with 2% glutaraldehyde is the only efficient method.

Cytotoxicity of separation orthodontic elastics.

Rogério Lacerda dos Santos, Matheus Melo Pithon, Fernanda Otaviano Martins , Maria Teresa Villela Romanos

Cytotoxicity. Elastics. Biocompatibility. Orthodontics.

Objective: To test the hypothesis that there is no difference in cytotoxicity between separating elastics of different manufacturers. 

Methods: The present article compared latex elastics (4.0 mm, 4.4 mm and 4.8 mm) of four different manufacturers. The sample was allocated to seven groups of 9 elastics: Group A (American Orthodontics, green color, modules), Groups M1 and M2 (Morelli, blue color, modules and free in pack respectively), Groups M3 and M4 (Morelli, green color, modules and free in pack respectively), Group U (Uniden, blue color, free in pack) and Group T (Tecnident, blue color, free in pack) regarding their possible cytotoxic effects on oral tissues. Cytotoxicity assays were performed using cell culture medium containing epithelioid-type cells (Hep-2 line) derived from human laryngeal carcinoma and submitted to the methods for evaluating the cytotoxicity by the ?dye-uptake? test, at time intervals 24, 48, 72 and 168 h. Data were compared by analysis of variance (ANOVA) and Tukey?s test (p < 0.05). 

Results: Results showed statistically significant difference (p < 0.05) between group U and all the other Groups (A, M1, M2, M3, M 4 and T) at 24 and 48 hours. 

Conclusions: Uniden elastics evoked more cell lysis at 24 and 48 h, although, all brands showed biocompatibility from 72 h onwards.


Different strategies used in the retention phase of orthodontic treatment

Vinicius Schau de Araújo Lima, Felipe de Assis Ribeiro Carvalho, Rhita Cristina Cunha Almeida, Jonas Capelli Junior

Retention. Relapse. Stability.

Objective: To identify most frequent clinical conducts, considering the following variables: 1) used appliances; 2) time of use; 3) protocol of use in daily hours and evolution with along time; 4) percentage of patients in follow up 1 year after treatment; and 5) most frequent observed relapses.. 

Methods: It was used a  questionnaire distributed to all specialization course of Orthodontics inscribed in the Brazilian Federal Council of Dentistry until October of 2005. 

Results and Conclusion: It was obtained 91 valid questionnaires. For data analysis were used descriptive statistics and chi-square for linear tendency and chi-square for linear trend and chi-square for multivariate linear trend. We can conclude that: 1) on upper arch, the most used appliances were Hawley, wraparound and  acetate plate; in the lower multi-stranded rod, steel rod not bonded to incisors and rod bonded to the incisors; 2) it was indicated its use for more than 24 months for the upper arch, with a trend toward its less use than in the lower arch; 3) the protocol of use in the upper arch begins with 24 hours/day, reducing after the second year; for the lower arch the protocol of hours/day was kept stable; 4) after 1 year of retention most than 50% of treated cases were re-examined; 5) most common relapses were crowding, giroversion and opening of diastemas.


Effects induced after the use of maxillary protraction appliances: A literature review

Adanai de Brito Freire, Leonard Euler Andrade Gomes do Nascimento, Ana de Lourdes Sá de Lira

Headgear Appliances. Angle Class III malocclusion. Maxilla.

Objective: The present literature review, examined the effects of maxillary protraction in patients treated with different types of facial masks.

Methods: The review searched for relevant articles, including randomized controlled trials, controlled clinical trials and uncontrolled trials. Comparisons were made between eight different types of facial masks: Delaire; Grummons; Petit; Turley; Batista; ?Sky Hook?; Nanda and Türbinger. Following aspects were evaluated: a) the type of anchorage; the origin, direction and magnitude of forces and b) the relevant results of following skeletal and dental measurements: angular (SNA and SNB), linear (AFAI); vertical angles (SN.GoGn, FMA); dental (IMPA) and linear (1-NA, 1-NB).

Conclusion: The results showed that there was no uniformity in the choice of anchorage type and form of application of forces between the facial masks examined, but there were similarities in skeletal and dental aspects: Anterior displacement of the maxillary complex (increase in SNA) ; anterior displacement of the upper anterior teeth (increase of 1-NA), the lingual inclination of mandibular incisors (decrease of 1-NB), down and back rotation of the mandible (increase AFAI, SN.GoGn, FMA, decrease in SNB).

Effect of rapid maxillary expansion on the dimension of the nasal cavity and on facial morphology assessed by acoustic rhinometry and rhinomanometry

Carla Enoki, Fabiana Cardoso Pereira Valera, Mirian Aiko Nakane Matsumoto, Wilma Terezinha Anselmo-Lima

Palatal expansion technique. Mouth breathing. Malocclusion. Cephalometry.

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Objective: To assess the effects of rapid maxillary expansion on facial morphology and on nasal cavity dimensions of mouth breathing children by acoustic rhinometry and computed rhinomanometry. 

Methods: Cohort; 29 mouth breathing children with posterior crossbite were evaluated. Orthodontic and otorhinolaryngologic documentation were performed at three different times, i.e., before expansion, immediately after and 90 days following expansion. 

Results: The expansion was accompanied by an increase of the maxillary and nasal bone transversal width. However, there were no significant differences in relation to mucosal area of the nose. Acoustic rhinometry showed no difference in the minimal cross-sectional area at the level of the valve and inferior turbinate between the periods analyzed, although rhinomanometry showed a statistically significant reduction in nasal resistance right after expansion, but were similar to pre-treatment values 90 days after expansion. 

Conclusion: The maxillary expansion increased the maxilla and nasal bony area, but was inefficient to increase the nasal mucosal area, and may lessen the nasal resistance, although there was no difference in nasal geometry. Significance: Nasal bony expansion is followed by a mucosal compensation.


Mini-implant and Nance button for initial retraction of maxillary canines: A prospective study in cast models

Flávia de Moraes Arantes, Juliana Kina, Matheus José Bueno Gonçalves, Júlio de Araújo Gurgel , Omar Gabriel da Silva Filho, Eduardo César Almada Santos

Orthodontic anchorage procedures. Dental casting technique. Orthodontics.

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Objective: Bone anchorage is a key factor for the successful management of some malocclusions for it allows the application of continuous forces, decreases treatment time and is independent from patient compliance.

Methods: The goal of this work was to establish a dental model comparison in order to measure the anchorage loss after the initial retraction of upper canines between the two groups. Group A used mini-implants and Group B used Nance button. All patients had two models cast (M1 and M2). The first models were taken on baseline (M1) and the other models were taken after canine retraction (M2).

Results: All measurements were pooled and submitted to statistical analysis. In order to verify the inter-examiner systematic error a paired t-test was performed. Dahlberg?s formula was used to estimate the casual error. For comparison purposes between Before and After stages, a paired t-test was done. For the comparison between mini-implant and Nance button groups, a Student t-test was applied. All tests adopted a 5% (p<0.05) significance level.

Conclusion: No statistically significant difference was observed between the two groups when measurements and comparisons to assess molar anchorage loss after canine initial retraction were performed. Two different anchorage systems were applied on dental models (mini-implants and Nance?s button) for each group.


Determination of the structural characteristics in youngsters from Ceará with Class II, division 1 malocclusion

Keila Maria de Sousa Castelo, Fausto Silva Bramante

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Objective:To determine the structural characteristics of Caucasian youths from Ceará State, Northeastern Brazil, 

presenting with Class II, Division 1 malocclusion and to investigate whether there is gender dimorphism based on 

the cephalometric variables assessed. 

Methods: By means of lateral cephalograms, it was possible to determine the cephalometric characteristics of 

Class II, Division 1 malocclusion in a sample of 50 Caucasian youths from Ceará State, Brazil, of both genders (25 

male and 25 female), aged between 9 and 14 years, who had not received previous orthodontic treatment. Sixteen 

cephalometric measures were evaluated and a comparison was made between the experimental group (Class II) 

and the control group (Class I), a sample comprising 50 Caucasian children from the Brazilian State of Ceará, of 

both genders (22 male and 28 female), aged 9 to 13 years, obtained from research conducted at the Study Center of 

the Federal University of Ceará (UCCB), Department of Orthodontics. 

Conclusions: Overall, the maxilla exhibited adequate positioning. The mandible showed a clear predominance 

of retrusion and dimensional changes in the sagittal direction. The facial vertical dimensions were increased. The 

maxillary incisors were well-positioned in their apical bases and with slight lingual inclination. The mandibular 

incisors were labially inclined and protruded. The study identified the presence of gender dimorphism in the following measures: P-Nperp, Co-A, Wits and ALFH.

BBO Case Report

Treatment of a Class III growing patient with mandibular prognathism and severe anterior crossbite*

Ricardo Machado Cruz

Class III. Chin cup. Anterior crossbite. Mandibular prognathism.

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The treatment of growing patients with Class III skeletal pattern represents one of the greatest clinical challenges for the orthodontist. Several treatment protocols have been proposed, almost all involving rapid maxillary expansion and maxillary protraction. However, there are cases where the maxilla is properly positioned in  the anteroposterior direction and there is no transverse discrepancy, featuring only a mandibular prognathism.  In such cases, when there is a set of favorable factors such as lack of laterognathism and lower mandibular plane  angle, a viable option and which could prove quite interesting is the use of orthodontic chin cup during the night,  aiming at trying to redirect the forward growth of the mandible. To have success, it is necessary that this procedure involves pubertal growth spurt and is extended to full skeletal maturation. This case was presented to the  board of the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as part of the requirements to  become a BBO Diplomate.

Special Article

Changes in occlusal plane through orthognathic surgery

Lucas Senhorinho Esteves, Carolina Ávila, Paulo José D’Albuquerque Medeiros

Occlusal plane. Orthognathic surgery. Ortho-surgical treatment.

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Introduction:A conventional ortho-surgical treatment, although with good clinical results, does not often achieve  the desired functional outcomes. Patients with dentofacial deformities, especially those with increased occlusal  planes (OP), are also affected by muscle, joint and breathing functional disorders, as well as facial esthetic involvement. The surgical manipulation of the OP in orthognathic surgery is an alternative to overcome the limitations of  conventional treatment. Objective: To report the importance of assessing the occlusal plane during diagnosis, planning and ortho-surgical  treatment of patients with facial skeletal deformities and its main advantages. Conclusion:Although both philosophies of ortho-surgical treatment (conventional and by surgical manipulation  of the OP) have presented good results, the selective correction of the OP allows a full treatment of these patients,  providing better esthetic and functional results.
Dental Press Journal of Orthodontics - v. 17, no. 4 Download full issue pdf