Dental Press Jounal of Orthodontics
Dental Press International

v. 18, no. 6

Dental Press Journal of Orthodontics – ISSN 2176-9451

Dental Press J. Orthod.

v. 18, no. 6

November / December

2013


Editorial

Adjustments to the editorial process

David Normando

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?People fear change. I fear that things never change.? (Chico Buarque)

When an article is submitted to Dental Press Journal of Orthodontics, the editor-in-chief carries out an initial analysis and decides whether that article is suitable for publication. Should that be the case, the article is sent to three or four reviewers. However, it is immediately sent back to the author if the editor-in-chief considers it unsuitable for publication. For such consideration, the following criteria are applied: low originality level, articles that replicate well-established scientific knowledge only or case reports that do not introduce any important innovations in the treatment of the malocclusion reported. We believe that speeding up this process, especially in cases of refusal, eases the feeling of disappointment caused by a negative response, particularly for young authors. 

The process, as it is nowadays, has led some authors to write letters to the editor. In fact, not many letters have been sent, but all questions have been carefully and respectfully analyzed and answered. As in any other submission system, our modus operandi is susceptible to flaws. It is important to emphasize that there is a probability of error in the evaluation process carried out by the editor-in-chief with regard to the quality of the submitted article. 

The Dental Press Journal of Orthodontics (DPJO) editorial board has continuously discussed all the questions involved in the peer-review process. And taking advantage of the considerable number of submissions ? a fact that is associated with the indexation of DPJO on PubMed1 ?, we decided to introduce a slight change to our editorial process. From 2014 onwards, all submitted articles will be forward to two associate editors for an initial analysis. Should both decide that the article is of low priority, it will be sent back to the author. Conversely, should at least one of the editors decide that the article is suitable for publication, it will continue on the submission process and will be thoroughly analyzed by a group of three to four reviewers. 

This initial analysis aforementioned will be carried out by a committee formed by: Daniela Garib, Flavia Artese, Matheus Pithon, Ildeu Andrade, Fernanda Angelieri and Leandro Marques. These eminent Brazilian scientists will be coordinated by the editor-in-chief and will scrutinize the article in order to assess its originality, the quality of its English and whether or not it is in accordance with the standards of the journal.  

The aim of this new assessment method is to reduce any bias in the peer-review process of this periodical.

 

David Normando – editor-in-chief 

(davidnormando@hotmail.com)

Orthodontics Highlights

Orthodontic Insight

Mouthwashes with hydrogen peroxide are carcinogenic, but are freely indicated on the Internet: warn your patients!

Hydrogen peroxide. Mouth washing. Rinsing. Teeth bleaching. Teeth whitening.

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It all began in Ancient Egypt where people used to bleach their teeth with antiseptic mouthwashes made of urea from human urine. Teeth harmony is promoted by expression of feelings, communication, a real window of the brain and its content! Tooth bleaching products are medicines, not cosmetics! Mouth washing with hydrogen peroxide is an illogical and dangerous procedure! Hydrogen peroxide must be used in one?s mouth only when employed by a dentist who has been properly instructed to protect the mucosa, preventing it from receiving these products. How and for how long these products are going to be used require caution in order to avoid or decrease any adverse effects on the tissues. Many websites instruct people on how to purchase and prepare hydrogen peroxide so that it is used as an antiseptic mouthwash and tooth bleaching agent. Some websites even refer to dentists as ?exploiters?, accusing them of not instructing patients properly. In this article, we aim at providing evidence and information upon which dentists and assistants may base their thinking as well as their opinion and procedures regarding ?the indiscriminate and free use of hydrogen peroxide in the mouth, on teeth and oral mucosa?. Those websites, blogs and social network profiles trespass the limits of public trust and should be immediately sued by the government for committing a crime against public health.

Evidence-based Orthodontics

Importance of the control group in scientific research
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Fundamentally, scientific research aims at contributing to the development of human knowledge in all areas, being systematically planned and executed according to rigorous criteria of information processing.1 It  consists of investigations, observations and experiments, and tries to use these tools to explain the causes of many phenomena.

[...]

Interview

An interview with Antônio Carlos de Oliveira Ruellas
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»Associate professor of Orthodontics, School of Dentistry ? Federal University of Rio de Janeiro (UFRJ).

»MSc and PhD in Dentistry (Orthodontics), School of Dentistry ? UFRJ.

»Former Professor at Federal University of Alfenas (Unifal) and University of Alfenas (Unifenas).

» Post-Doc in Materials Sciences at the Military Institute of Engineering (IME).

With joy and trust, I have accepted the invitation to coordinate this interview with professor Dr. Antônio Carlos de Oliveira Ruellas, one of the most renowned men in Brazilian Orthodontics. For those who do not know him, he is from the town of Areado (near the cities of Alfenas and Poços de Caldas) in the state of Minas Gerais. In 1989, he got a degree in Dentistry (School of Pharmacy and Dentistry ? Alfenas ? EFOA/Unifal) and two years later, under the advice of professor Walter Alves Araújo, he began his career as a professor of Dentistry at the University of Alfenas/Unifenas while he was still in the undergraduate course. Later on, professor Ruellas taught Physics at a university entrance exam preparation course in Alfenas. Subsequently, he went for the masters and doctorate degree in Orthodontics at the Federal University of Rio de Janeiro (UFRJ) where he stood out as one of the best students and, later on, one of the professors of that renowned institution ? a position he has skillfully occupied until these days. Professor Ruellas has recently finished his post-doc in Engineering of Metal and Materials at the Military Institute of Engineering (IME). He has published more than 190 articles in national and international periodicals, in addition to two books (his most recent books is entitled ?Biomechanics applied to the clinical practice?, a masterpiece of the orthodontic literature), among others. Professor Ruellas stands out from the crowd not only for his titles, academic production and attributes, but even more for his simplicity, humbleness and generosity towards those around him. He has always supported his students to go beyond him by saying ?My students should be better than I am, and their students should be better than what they are??. At work, he passes on everything he knows, and when he does not know something, he admits it, always seeking more and more knowledge. I consider professor Antônio Carlos as my orthodontic father ? I dived into Orthodontics because of his advice and his lessons. I had the privilege of being his student during the undergraduate, postgraduate, masters and doctorate courses. And that makes me very proud. I do not know anyone else who has had the privilege of being his student during all learning stages. I would like to end this preface by inviting everyone to read and enjoy this interview that will certainly expand our orthodontic knowledge. 

Matheus Melo Pithon

Original Article

Surface morphology changes of acrylic resins during finishing and polishing phases

Acrylic resins. Scanning electron microscopy. Surface properties.

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Introduction: The finishing and polishing phases are essential to improve smoothness and shining on the surface of acrylic resins used to make removable orthodontic appliances. A good surface finishing reduces roughness, which facilitates hygiene, prevents staining and provides greater comfort to the patients. 

Objective: The aim of this paper was to analyze the changes on surface morphology of acrylic resins during finishing and polishing phases.

Methods: Thirty discs (10 mm in diameter and 5 mm in length) were made with acrylic resin and randomly divided into ten groups. The control group did not receive any treatment while the other groups received gradual finishing and polishing. The last group received  the entire finishing and polishing procedures. Surface morphology was qualitatively analyzed through scanning electron microscopy and quantitatively analyzed through a laser profilometer test.

Results: The acrylic resin surfaces without treatment showed bubbles which were not observed in the subsequent phases. Wearing out with multilaminated burs, finishing with wood sandpaper and finishing with water sandpaper resulted in surfaces with decreasing irregularities. The surfaces that were polished with pumice and with low abrasive liquids showed high superficial smoothness.

Conclusion: Highly smooth acrylic resin surfaces can be obtained after mechanical finishing and polishing performed with multilaminated burs, wood sandpaper, water sandpaper, pumice and low abrasive liquids.

Clinical evaluation of dental alignment and leveling with three different types of orthodontic wires

Orthodontic wires. Physical properties. Tooth movement. Orthodontics.

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Introduction: A wide variety of orthodontic wires made of different alloys is available to be used in orthodontic practice and may produce different clinical responses during tooth movement.

Objective: This research evaluated the alignment and leveling of lower dental arches after the use of three types of orthodontic wires.

Methods: A sample of 36 patients was randomly divided into 3 groups: stainless steel, multistranded steel and superelastic nickel-titanium, according to the first leveling arches used. In order to observe differences in tooth position and axial inclination of the lower incisors, all patients had lateral cephalometric radiographs taken before the insertion of the first arches and 2 months later. The irregularity index and the curve of Spee were measured, compared between groups and considered influential on the proclination of incisors during the initial phase of alignment and leveling. The Reflex microscope was used to measure the irregularity index, whereas the ANOVA analysis of variance was used to verify differences between groups with regard to the degree of dental alignment and leveling.

Results: There were significant differences between groups only at T2 for the irregularity index.

Conclusion: The NiTi and multistranded steel wires showed greater aligning capacity when compared with stainless steel wires.

Cone beam tomographic study of facial structures haracteristics at rest and wide smile, and their correlation with the facial types

Diagnosis. Cone beam computed tomography. Smile.

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Objective: To determine the characteristics of facial soft tissues at rest and wide smile, and their possible relation to the facial type.

Methods: We analyzed a sample of forty-eight young female adults, aged between 10, 19 and 40 years old, with a mean age of 30.9 years, who had balanced profile and passive lip seal. Cone beam computed tomographies were performed at rest and wide smile postures on the entire sample which was divided into three groups according to individual facial types. Soft tissue features analysis of the lips, nose, zygoma and chin were done in sagittal, axial and frontal axis tomographic views.

Results: No differences were observed in any of the facial type variables for the static analysis of facial structures at both rest and wide smile postures. Dynamic analysis showed that brachifacial types are more sensitive to movement, presenting greater sagittal lip contraction. However, the lip movement produced by this type of face results in a narrow smile, with smaller tooth exposure area when compared with other facial types.


Conclusion: Findings pointed out that the position of the upper lip should be ahead of the lower lip, and the latter, ahead of the pogonion. It was also found that the facial type does not impact the positioning of these structures. Additionally, the use of cone beam computed tomography may be a valuable method to study craniofacial features.

The influence of protective varnish on the integrity of orthodontic cements

Glass-ionomer cements. Artificial saliva. Microhardness.

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Objective: The aim of the present study was to assess the influence of saliva contamination over the structural strength and integrity of conventional glass-ionomer cements used for cementing orthodontic bands in the absence and presence of a surface-protecting varnish. 

Method: 48 samples were prepared by inserting 3 types of glass-ionomer cements into standardized metallic matrixes of 10 mm of diameter and 2 mm of depth. The cements used were: Meron (VOCO), Ketac-Cem (3M ESPE) and Vidrion C (DFL), all of which comprised groups A, B and C, respectively. Subgroups A1, B1 and C1 comprised samples with no surface protection, whereas subgroups A2, B2 and C2 comprised samples of which surface was coated with Cavitine varnish (SS White), after cement manipulation and application, in order to protect the cement applied. All samples were stored in artificial saliva for 24 hours at 37°C. A Vickers diamond micro-durometer was used to produce indentations on the non-treated group (non-varnished) and the treated group (varnished). 

Results: Varnished materials had significantly higher microhardness values in comparison to non-varnished materials. Ketac-Cem had the highest microhardness value among the varnished materials. 


Conclusion: Varnish application is necessary to preserve the cement and avoid enamel decalcification. Glass-ionomer cements should be protected in order to fully keep their properties, thus, contributing to dental health during orthodontic treatment.

Comparative study on direct and indirect bracket bonding techniques regarding time length and bracket detachment

Corrective orthodontics. Orthodontic brackets. Dental bonding. Dental detachment.

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Objective: The aim of this study was to assess the time spent for direct (DBB - direct bracket bonding) and indirect (IBB - indirect bracket bonding) bracket bonding techniques. The time length of laboratorial (IBB) and clinical steps (DBB and IBB) as well as the prevalence of loose bracket after a 24-week follow-up were evaluated.

Methods: Seventeen patients (7 men and 10 women) with a mean age of 21 years, requiring orthodontic treatment were selected for this study. A total of 304 brackets were used (151 DBB and 153 IBB). The same bracket type and bonding material were used in both groups. Data were submitted to statistical analysis by Wilcoxon non-parametric test at 5% level of significance.

Results: Considering the total time length, the IBB technique was more time-consuming than the DBB (p < 0.001). However, considering only the clinical phase, the IBB took less time than the DBB (p < 0.001). There was no significant difference (p = 0.910) for the time spent during laboratorial positioning of the brackets and clinical session for IBB in comparison to the clinical procedure for DBB. Additionally, no difference was found as for the prevalence of loose bracket between both groups.


Conclusion: the IBB can be suggested as a valid clinical procedure since the clinical session was faster and the total time spent for laboratorial positioning of the brackets and clinical procedure was similar to that of DBB. In addition, both approaches resulted in similar frequency of loose bracket. 

Comparative cephalometric study of Class II malocclusion treatment with Pendulum and Jones jig appliances followed by fixed corrective orthodontics

Angle Class II malocclusion. Corrective orthodontics. Molar tooth.

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Objective: The purpose of this study was to cephalometrically compare the skeletal and dentoalveolar effects in the treatment of Class II malocclusion with Pendulum and Jones jig appliances, followed by fixed corrective orthodontics, and to compare such effects to a control group.

Methods: The sample was divided into three groups. Group 1: 18 patients treated with Pendulum, Group 2: 25 patients treated with Jones jig, and Group 3: 19 young subjects with untreated Class II malocclusions and initial mean age of 12.88 years. The chi-square test was applied to assess severity and gender distribution. Groups 1 and 2 were compared to the control group by means of the one-way ANOVA and Tukey tests in order to differentiate treatment changes from those occurred by craniofacial growth.

Results: There were no significant changes among the three groups with regard to the components of the maxilla and the mandible, maxillomandibular relationship, cephalometric and tegumental pattern. Buccal tipping of mandibular incisors was significantly greater in the experimental groups and increased mesial angulation of the maxillary second molars was found in the Jones jig group. In the experimental groups, dental relationship, overbite and overjet were corrected. 


Conclusion: It can be stated that the distalization achieved its purpose of correcting the Class II.

Brazilian orthodontists and the legal issues involving their professional activity: A legal and behavioral proposal

Brazil. Agreements. Informed consent. Documents. Legal responsibility.

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Objective: The aim of this study was to review the use of orthodontic records (OTR?s) by Brazilian orthodontists and propose a behavioral approach from a legal point of view, drawing on their interpersonal relationship with their patients.

Methods: A statistical cross-analysis was performed to compare five groups. A sixth group was created comprising the intersection of the responses provided by the five aforementioned groups.

Results: The results demonstrate that 42.2% of orthodontists require initial and final records and keep orthodontic records  throughout their professional career; 13.9% duplicate the initial records and consider patients as the lawful owners of these documents; 19.5% make use of a medical history questionnaire, to be duly signed by all patients; 5.4% acknowledge that the decision to undergo treatment is ultimately the patient?s, and, therefore, an alternative response ?not perform the treatment? should be included in the questionnaire; 24% recognize the importance of the Consumer Protection Code (CPC), regard the provision of orthodontic services as an obligation of means; and  explain to the patient the risks involved in orthodontic practice. Among the 1,469 orthodontists researched, 0% simultaneously took into account all aspects of this study. 


Conclusion: It was concluded that Brazilian orthodontists adopt a mistaken legal, professional and behavioral attitude, neglecting to build patient?s orthodontic record with due care and in accordance with the law, which makes them vulnerable to patient disputes, contentious or otherwise.  

Orthodontic movement of teeth with short root anomaly: Should it be avoided, faced or ignored?

Tooth root. Tooth abnormalities. Root resorption. Orthodontics.

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Introduction: Short Root Anomaly (SRA) is an uncommon disease and a challenge for orthodontic treatment as it tends to increase the risk of root resorption.

Objective: Assess the current status of the diagnosis, etiology and orthodontic management of teeth with SRA, and present case reports.

Method: A literature review was carried out in PubMed, SciELO, LILACS, Scopus and Web of Science databases.

Results: A differential diagnosis of SRA should be conducted for teeth with incomplete root formation, external apical root resorption, dentin dysplasia type I and post dental trauma root hypoplasia. SRA is genetically determined and orthodontic movement requires changes in clinical and radiographic management in order to restrict damage. 

Conclusion: Orthodontic movement of teeth with SRA is contraindicated in extreme cases, only. Caution at all stages could minimize attachment loss and lead to long-term stability. 

Procedures adopted by orthodontists for space closure and anchorage control

Orthodontic anchorage procedures. Orthodontic space closure. Questionnaires.

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Objective: The aim of this study was to identify the procedures adopted by Brazilian orthodontists in the following situations: extraction space closure, anchorage control in case of necessary anchorage for group A and frequency of skeletal anchorage use, especially in the upper jaw.

Method: A questionnaire was sent to the e-mail address of all dentists registered in the Brazilian Federal Council of Dentistry.

Results: The results showed that most Brazilian orthodontists usually perform extraction space closure by means of sliding mechanics. The use of palatal bar, inclusion of second molars in the archwire and space closure performed in two phases are the most used techniques for anchorage control in the upper jaw. The skeletal anchorage is referenced by 36.5% of specialists as a routine practice for the upper jaw anchorage.


Conclusions: There is a wide variety of procedures adopted by Brazilian orthodontists for orthodontic space closure and anchorage control.

Prevalence of mesiodens in orthodontic patients with deciduous and mixed dentition and its association with other dental anomalies

Supernumerary tooth. Child. Prevalence.

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Objective: To determine the prevalence of mesiodens in deciduous and mixed dentitions and its association with other dental anomalies.

Material and Methods: Panoramic radiographs of 1,995 orthodontic patients were analyzed retrospectively, obtaining a final sample of 30 patients with mesiodens. The following aspects were analyzed: gender ; number of mesiodens; proportion between erupted and non-erupted mesiodens; initial position of the supernumerary tooth; related complications; treatment plan accomplished; and associated dental anomalies. The frequency of dental anomalies in the sample was compared to reference values for the general population using the chi-square test (c2), with a significance level set at 5%.

Results: The prevalence of mesiodens was 1.5% more common among males (1.5:1). Most of the mesiodens were non-erupted (75%) and in a vertical position, facing the oral cavity. Extraction of the mesiodens was the most common treatment. The main complications associated with mesiodens were: delayed eruption of permanent incisors (34.28%) and midline diastema (28.57%). From all the dental anomalies analyzed, only the prevalence of maxillary lateral incisor agenesis was higher in comparison to the general population.


Conclusion: There was a low prevalence of mesiodens (1.5%) in deciduous and mixed dentition and the condition was not associated with other dental anomalies, except for the maxillary lateral incisor agenesis.

Applicability of Moyers analysis in mixed dentition: A systematic review

Mixed dentition. Malocclusion. Dental eruption.

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Introduction: Moyers analysis is widely used for analyzing mixed dentition, however, the accuracy of its theoretical probability tables has been recently questioned. Taking into consideration the fact the mixed dentition analysis is of paramount importance to precisely determine the space needed for alignment of canines and premolars, this research aimed at objectively assessing in the literature such an important step for orthodontic diagnosis. 

Methods: A computerized search involving articles published on PubMed and Lilacs between 1990 and September, 2011 was conducted in accordance with the method described in the Cochrane 5.1.0 handbook. 

Results: The research resulted in a sample composed of 629 articles. The inclusion criteria were: Articles using the Moyers analysis with a sample greater or equal to 40 patients. Conversely, the exclusion criteria were: Dental casts of patients with syndromes or oral cleft, researches conducted with a literature review, only, or clinical case reports and researches conducted before 1990. For this systematic review, 19 articles were selected. 


Conclusion: Based on the literature available, we can conclude that the Moyers mixed dentition analysis must be carefully used, since the majority of the articles analyzed showed that the probability of 75% was not as accurate as expected, leading to the need of adapting the probability levels depending on the study population.

Assessment of first molars sagittal and rotational position in Class II, division 1 malocclusion

Molar tooth. Angle Class II malocclusion. Orthodontics.

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Objective: This study assessed the anterior-posterior positioning of the upper and lower first molars, and the degree of rotation of the upper first molars in individuals with Class II, division 1, malocclusion.

Methods: Asymmetry I, an accurate device, was used to assess sixty sets of dental casts from 27 females and 33 males, aged between 12 and 21 years old, with bilateral Class II, division 1. The sagittal position of the molars was determined by positioning the casts onto the device, considering the midpalatal suture as a symmetry reference, and then measuring the distance between the mesial marginal ridge of the most distal molar and the mesial marginal ridge of its counterpart. With regard to the degree of rotation of the upper molar, the distance between landmarks on the mesial marginal ridge was measured. Chi-square test with a 5% significance level was used to verify the variation in molars position. Student?s t test at 5% significance was used for statistical analysis.

Results: A great number of lower molars mesially positioned was registered, and the comparison between the right and left sides also demonstrated a higher number of mesially positioned molars on the right side of both arches. The average rotation of the molars was found to be 0.76 mm and 0.93 mm for the right and left sides, respectively. 


Conclusion: No statistically significant difference was detected between the mean values of molars mesialization regardless of the side and arch. Molars rotation, measured in millimeters, represented ¼ of Class II.

Prototype of a new tip developed to be coupled to dental light-curing units for optimizing bonding of orthodontic brackets and accessories

Light-curing of dental adhesives. Orthodontic brackets. Patents. Shear strength.

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Objective: development of a new device to be coupled to light-curing units for bonding orthodontic brackets and accessories, and test its efficacy in an in vitro mechanical trial. The inner surface of the device is mirrored and is based on physical concepts of light refraction and reflection. The main advantage of such device is the reduced clinical time needed for bonding and the low possibility of contamination during the process.

Methods: One hundred and twenty specimens were used for testing the shear bond strength of brackets bonded with the device. The Adhesive Remnant Index (ARI) was also determined. The sample was divided into 2 groups. In group 1 a halogen light-curing unit was used while in group 2 a led light-curing unit was used. Each group was then subdivided. In subgroups H1 and L1, a conventional light guide rod was used while in subgroups H2 and L2 bonding was performed with the mirrored device coupled to the tip of the guide light rod. 

Results: The values obtained for the shear bond strength and the ARI in the subgroups were compared. Results showed that there was no statistically significant difference for the shear strength (p > 0.05) and the ARI (p > 0.05) between the subgroups. 


Conclusion: The tests of mechanical trials and the ARI analysis showed that the new device fulfilled the requirements for bonding orthodontic accessories, and that the time for bonding was reduced to half, being necessary only one light exposure.

Pain, masticatory performance and swallowing threshold in orthodontic patients

Mastication. Malocclusion. Orthodontics.

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Objective: The aim of this study was to assess pain, masticatory performance and swallowing threshold of patients undergoing orthodontic treatment. 

Methods: Ten patients of both genders (mean age of 17.25 ± 5.21 years), with complete permanent dentition, who underwent orthodontic treatment with fixed appliances were evaluated. The masticatory performance and the swallowing threshold were assessed by patient?s individual capacity of fragmenting an artificial test food (Optocal) which was chewed and had the resulting particles processed by a standardized sieving method, presenting the median particle size (MPS) of crushed units. The intensity of pain / discomfort during chewing was evaluated by means of a visual analog scale. All tests were performed at the following times: T0 ? before activating the orthodontic appliance; T1 ? 24 hours after activation, and T2 ? 30 days after activation.

Results: The results showed a significant increase in pain at T1 (T0 ? 0.60 ± 0.70 mm; T1 ? 66.2 ± 34.5 mm), returning to baseline values at T2 (3.20 ± 3.82 mm). Masticatory performance was also reduced in T1 (MPS 10.15 ± 1.1 mm2) in comparison to T0 (MPS 7.01 ± 2.9 mm2) and T2 (MPS 6.76 ± 1.3 mm2). However, particle size was not affected in the swallowing threshold test (T0 ? 5.47 ± 2.37 mm2; T1 ? 6.19 ± 2.05 mm2; T2 ? 5.94 ± 2.36 mm2).


Conclusion: The orthodontic appliances did not interfere in the size of the particles that would be swallowed, even in the presence of pain.

Flexural strength of mini-implants developed for Herbst appliance skeletal anchorage. A study in Minipigs br1 cadavers

Functional appliances. Dental implants. Orthodontic appliances. Orthodontic anchorage procedures. Angle Class II malocclusion.

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Objective: The present study was designed to verify if mini-implant prototypes (MIP) developed for Herbst appliance anchorage are capable of withstanding orthopedic forces, and to determine whether the flexural strength of these MIP varies depending on the site of insertion (maxilla and mandible).

Methods: Thirteen MIP were inserted in three minipig cadavers (six in the maxilla and seven in the mandible). The specimens were prepared and submitted to mechanical testing. The mean and standard deviation were calculated for each region. A two-way Student?s t test was used to compare the strength between the sites. A one-way Student?s t test was performed to test the hypothesis. Orthopedic forces above 1.0 kgf were considered. 

Results: The MIP supported flexural strength higher than 1.0 kgf (13.8 ± 2.3 Kg, in the posterior region of the maxilla and 20.5 ± 5.2 Kg in the anterior region of the mandible) with a significantly lower flexural strength in the anterior region of the mandible (P < 0.05). 


Conclusion: The MIP are capable of withstanding orthopedic forces, and are more resistant in the anterior region of the mandible than in the posterior region of the maxilla in Minipigs br1 cadavers.

BBO Case Report

Treatment of dental and skeletal bimaxillary protrusion in patient with Angle Class I malocclusion

Class I malocclusion. Corrective orthodontics. Esthetics.

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In the orthodontic clinic, skeletal and dental bimaxillary protrusion is presented frequently as one of the factors leading patients to seek orthodontic treatment, mainly due to the esthetic involvement it has. The patient of this article illustrates this situation, being deeply uncomfortable with her esthetic appearance, due to the excessive upper incisors exposure and problems with lip sealing. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO), as part of the requisites to become a BBO Diplomate. 

Special Article

Reconstruction of alveolar cleft with allogenous bone graft: Clinical considerations

Orthodontics. Cleft palate. Bone transplant.

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Introduction: Secondary bone grafting consists in a routine procedure on the treatment of patients with alveolar cleft. Usually, it is performed by the end of the mixed dentition, when the permanent canine is erupting, with autogenous cancellous bone from the iliac crest. 


Objective: The present article discusses the alternative of autogenous bone grafting with allogeneic bone, obtained from human bone bank, illustrating the result with the presentation of a clinical case of left unilateral alveolar cleft.

Dental Press Journal of Orthodontics - v. 18, no. 6 Download full issue pdf