Comparative efficiency of Class II malocclusion treatment with the pendulum appliance or two maxillary premolar extractions and edgewire appliances

The objective of this study was to compare, on study models and initial cephalograms, the efficiency of Class II malocclusion treatment with the pendulum appliance, and with two maxillary premolar extraction protocol. The sample consisted of 48 treated Class II malocclusion patients: group 1 comprised 22 patients (7 males, 15 females) treated with the pendulum appliance, with an initial mean age of 14.44 years and group 2, 26 patients (14 males, 12 females) treated with two maxillary premolar extractions at an initial mean age of 13.66 years. To compare the efficiency of each treatment protocol, the occlusal outcomes were evaluated on dental casts using the Peer Assessment Rating (PAR) Index and the treatment time (TT) of each group was calculated on clinical charts. The degree of treatment efficiency was calculated as the ratio between the percentage of occlusal improvement, evaluated through the PAR index, and TT. Statistical analysis was undertaken by means of t-tests. The findings demonstrated that the two maxillary premolar extraction protocol provided the occlusal outcomes in a shorter time (group 1: 45.7 months, group 2: 23.01 months) and, therefore, demonstrated greater treatment efficiency than the pendulum appliance.

Treatment of a Class II subdivision malocclusion with multiple congenitally missing teeth

This case report describes the treatment of a patient with a Class II Division 1 subdivision right malocclusion with 8 congenitally missing teeth, incompetent lips, and incisor protrusion. The treatment plan included extractions and space closure with retraction of the anterior teeth; symmetric mechanics were used in the mandibular arch and asymmetric mechanics in the maxillary arch. Because of the mechanics used, some midline deviations were expected. Knowledge of diagnosis and treatment planning of asymmetric malocclusions and dental esthetics are essential for success when correcting asymmetic problems, but, even so, small clinical compromises should be expected. (Am J Orthod Dentofacial Orthop 2009; 135: 663-70)

Comparative distalization effects of Jones jig and pendulum appliances

Introduction: In this study, we compared the dentoalveolar changes of Class II patients treated with Jones jig and pendulum appliances. Methods: The experimental group comprised 40 Class II malocclusion subjects, divided into 2 groups: group 1 consisted of 20 patients (11 boys, 9 girls) at a mean pretreatment age of 13.17 years, treated with the Jones jig appliance for 0.91 years; group 2 comprised 20 patients (8 boys, 12 grls) at a mean pretreatment age of 13.98 years, treated with the pendulum appliance for 1.18 years. Only active treatment time of molar distalization was evaluated in the predistalization and postdistalization lateral cephalograms. Molar, second premolar, and incisor angular and linear variables were obtained. The intergroup treatment changes in these variables were compared with independent t tests. Results: The maxillary second premolars showed greater mesial tipping and extrusion in the Jones jig group, indicating more anchorage loss during molar distalization with this appliance. The amounts and the monthly rates of molar distalization were similar in both groups. Conclusions: The Jones jig group showed greater mesial tipping and extrusion of the maxillary second premolars. The mean amounts and the monthly rates of first molar distalization were similar in both groups. (Am J Orthod Dentofacial Orthop 2009;135:336-42)

Comparison of the effects produced by headgear and pendulum appliances followed by fixed orthodontic treatment

This study compared the effects produced by two different molar distalizers, namely cervical headgear (CHG) and the intraoral pendulum appliance, associated with fixed orthodontic appliances. The headgear group comprised 30 patients (19 females, 11 males), with an initial age of 13.07 years [standard deviation (SD) = 1.3], treated with CHG and fixed orthodontic appliances for a mean period of 3.28 years, and the pendulum group 22 patients (15 females, 7 males), with initial age of 13.75 years (SD = 1.86), treated with the pendulum appliance followed by fixed orthodontic appliances for a mean period of 4.12 years. Lateral cephalograms were taken at the start (T1) and on completion (T2) of orthodontic treatment. The pendulum and CHG groups were similar as to initial age, severity of the Class II malocclusion, gender distribution, initial cephalometric characteristics, and initial and final treatment priority index (TPI). Only treatment time was not similar between the groups, with a need for annualization for data for the pendulum group. The data were compared with independent t-tests. There was significantly greater restriction of maxillary forward growth and improvement of the skeletal maxillomandibular relationship in the CHG group (P < 0.05). The maxillary molars were more mesially tipped and extruded and the mandibular molars more uprighted in the CHG group compared with the pendulum group (P < 0.05). There was more labial tipping of the mandibular incisors and greater overbite reduction in the pendulum group. The pendulum appliance produced only dentoalveolar effects, different from the CHG appliance, which restricted maxillary forward displacement, thus improving the skeletal maxillomandibular relationship.

Influence of root parallelism on the stability of extraction-site closures

Introduction: In premolar extraction cases, root parallelism is recommended to preserve the stability of space closures. The influence of the degree of root parallelism on relapse of tooth extraction spaces has been a controversial topic in the literature. The aim of this study was to compare the angle between the long axes of the canine and the second premolarin patients with and without stability of extraction-space closures. Methods: A sample of 56 patients, treated with 4 premolar extractions, was divided into 2 groups: group 1, consisting of 25 patients with reopening of extraction spaces; and group 2, consisting of 31 patients without reopening of extraction spaces. Panoramic radiographs of each patient were analyzed at the posttreatment and 1-year posttreatment stages. The data were statistically analyzed by using chi-square tests, t tests, analysis of variance (ANOVA), and Pearson correlation coefficients. Results: The results showed that the groups did not differ regarding the angle between the canine and the second premolar, and there was no correlation between angular changes and reopening of extraction spaces, showing that dental angular changes are not determining factors for relapse, and other factors should be investigated. Conclusions: The final angle and the posttreatment changes observed in the angle between the long axes of the canine and the second premolar showed no influence on the relapse of extraction spaces. (Am J Orthod Dentofacial Orthop 2011; 139: e505-e510)

Effect of oxalate desensitizers and dentin moisture during total-etch bonding

Purpose: To evaluate the effect of oxalate during total-etch bonding, under different dentin moisture conditions, over time. The null hypothesis tested was that microtensile bond strength (mu TBS) was not affected by oxalate treatment and dentin moisture during two evaluation periods. Methods: Extracted human third molars had their mid-coronal dentin exposed flat and polished with 600-grit SiC paper. The surfaces were etched with 35% phosphoric acid for 15 seconds, washed and blot dried. After etching, a 3% potassium oxalate gel was applied for 120 seconds, except for the control group (no desensitizer). The surface was then washed and left moist (Wet bonding) or air-dried for 30 seconds (Dry bonding). The surfaces were bonded with: (I) two 2-step etch-and-rinse adhesives: Single Bond (SB); Prime & Bond NT (PBNT) and (2) one 3-step etch-and-rinse adhesive: Scotchbond Multi Purpose (SBMP). Composite buildups were constructed incrementally with Tetric Ceram resin composite. Each increment was cured for 40 seconds. After storage in water for 24 hours or 1 year at 37 C, the specimens were prepared for mu TBS testing with a cross-sectional area of approximately 1 mm(2). They were then tested in tension in an Instron machine at 0.5 mm/minute. Data were analyzed by ANOVA and Student-Newman-Keuls at alpha = 0.05. Results: Application of potassium oxalate had no significant effect on the bond strengths of SBMP and PBNT, regardless of the surface moisture condition (P > 0.05). Conversely, reduced bond strengths were observed after oxalate treatment for SB in both moisture conditions, that being significantly lower when using a dry-bonding procedure (P < 0.05). Lower bond strength was obtained for PBNT when a dry-bonding technique was used, regardless of the oxalate treatment (P < 0.05). After aging the specimens for 1 year, bond strengths decreased. Smaller reductions were observed for SBMP, regardless of moisture conditions. For the WB technique, smaller reductions after 1 year were observed without oxalate treatment for SB and after oxalate treatment for PBNT. (Am J Dent 2010;23:137-141).

Gingival recession in maxillary canines and central incisors of individuals with clefts

Background. Mucogingival alterations are inherent to clefts and may be worsened by the several plastic surgeries required in these individuals. Objective. The aim of this study was to evaluate the prevalence, severity, and some possible etiologic factors of gingival recessions in teeth adjacent to the cleft. Study design. A total of 641 teeth ( maxillary canines and central incisors) of 193 individuals with cleft lip and/or palate were examined. A generalized linear model was used, and the Wilcoxon test was used to compare the recession with cleft types. Results. Comparison among cleft types as to the presence of recession revealed a statistically significant positive relationship for the maxillary right and left central incisors only in the group with left cleft lip, alveolus, and palate (P = .034). The most frequently affected tooth was the right maxillary canine (26.16%). Conclusion. The prevalence of recession in teeth close to the cleft was higher, although it was not very severe. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 37-45)

Esthetic Analysis of Gingival Components of Smile and Degree of Satisfaction in Individuals With Cleft Lip and Palate

Objective: To evaluate soft tissue characteristics in individuals with cleft lip and palate and the degree of satisfaction of these individuals after rehabilitation. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. Patients: Forty-five individuals with repaired complete unilateral cleft lip and palate, aged 15 to 30 years. Interventions: One hundred thirty-five frontal facial photographs were obtained at rest and in natural and forced smile. Specialists in periodontics evaluated the soft tissue characteristics. Both patients and specialists evaluated the smiles and scored them as esthetically unpleasant, acceptable, or pleasant. Main Outcome Measures: Comparison of the cleft area with the contralateral region was performed for evaluation of soft tissue. The results of the degree of satisfaction with smile were expressed as percentages and means. The findings between patients and periodontists experienced or inexperienced with cleft care were compared. Results: Statistically significant differences were observed for alveolar process deficiency and absence of papilla in the esthetic area between groups (p < .05). Results show 84.4% of individuals considered their smile as esthetically pleasant. Specialists in periodontics of both groups scored the natural smile and forced smile as esthetically acceptable. There was a statistically significant difference in the mean of patients compared with both groups of specialists in periodontics (p < .05). Conclusions: Evaluation and knowledge of the soft tissue characteristics is extremely important for successful rehabilitation. The esthetic values and degree of patient satisfaction are essential for treatment success, since smile reconstruction should be esthetically pleasant to the patient.

Are Teeth Close to the Cleft More Susceptible to Periodontal Disease?

Objective: To evaluate whether teeth close to the cleft area present higher prevalence and severity of periodontal disease than teeth in other regions. Design: Cross-sectional. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo. Patients: There were 400 Individuals with complete unilateral or bilateral cleft lip and palate, aged 15 to 49 years, without any previous periodontal treatment. Main Outcome Measures: All clinical parameters were evaluated in six sites for each tooth. The arithmetic means were calculated for each sextant. Results: Of the sextants, 86.75% presented means of probing depth smaller than or equal to 3 mm. No sextant exhibited means of probing depth greater than or equal to 6 mm. There was a statistically significant difference (p < .001) in probing depth according to age, types of cleft, and sextant; 95.87% of sextants presented mean attachment levels smaller than or equal to 3 mm, The sextant with cleft did not present higher means of probing depth, clinical attachment level, plaque index, and gingival index. There was gingival bleeding in 99.08% of the sample and plaque In 97.40%. The type of cleft was not an Important factor Influencing the prevalence of periodontal disease. Age seems to be an Important factor influencing the prevalence and severity of periodontal disease for all aspects Investigated. Conclusions: Periodontal disease In individuals with clefts occurred in a similar manner as observed in other populations. The presence of the cleft does not seem to Increase the prevalence of the disease.

A modified approach for vestibuloplasty in severely resorbed mandible using an implant-retained postoperative stent: a case report

Background. Severely resorbed mandibles often present a short band of keratinized tissue associated with a shallow vestibule. As a result, prominent muscle insertions are present, especially in the mental region of the mandible. This case report describes the deepening of the vestibular sulcus in an atrophic mandible by combining free gingival grafts harvested from the palate and a postoperative acrylic resin stent screwed on osseointegrated implants placed at the anterior region of the mandible. Study design. During the second-stage surgery, a split-thickness labial flap was reflected and apically sutured onto the periosteum. Two free gingival grafts were obtained and then sutured at this recipient site. A previously custom-made acrylic stent was then screwed onto the most distally positioned implants. To document the procedure`s stability over time, a metal ball was placed in the most apical part of the vestibule and standardized cephalometric radiographs were taken before and 6 months after the procedure. Linear measurements of vestibular depths over the observation time were realized using specific software for radiographic analysis. Results. The proposed technique augmented the band of attached masticatory mucosa, deepened the vestibule and prevented the muscle reinsertion. The difference between the 2 measurements of vestibular depths was 9.39 mm (initial 20.88 mm, final 11.49 mm) after a 6-month postoperative period. Conclusion. The technique, in combination with palatal mucosal graft and use of a postoperative stent, decreased the pull of mentalis muscle and provided a peri-implantally stable soft tissue around implants. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: e7-e14)

Evaluation of the presence or absence of papilla between tooth and implant

Objective: The purpose of this study was to evaluate the papilla level adjacent to single-tooth implants in the maxillary anterior region in individuals with cleft lip, alveolus, and palate to verify whether there is correlation among the vertical distance, horizontal distance, dental/prosthetic crown shape, and periodontal/peri-implant biotype with the presence of interproximal papilla. Design: Cross-sectional. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (HRAC/USP). Patients: 77 papillae in 40 patients. Interventions: The periodontal/peri-implant biotype was clinically evaluated and characterized as thin or thick. Intraoral photographs were used to evaluate the presence or absence of papilla. Main Outcome Measures: Classification in scores (0 to 3) and determination of length (CL) and width (CW) of crowns adjacent to papillae. The CW/CL ratio was calculated for each crown in order to characterize it as square-shaped or triangular-shaped. The vertical and horizontal distances were obtained by radiographic evaluation. Results: The correlations between vertical distance and papilla score and horizontal distance and papilla score were statistically significant (p= .02 and p = .01). There was no significant difference between crown shape and periodontal/peri-implant biotype in distinct correlations with the papilla score (p = .41 and p = .07). Conclusion: The results suggest that the vertical and horizontal distances may have independent or combined relationship with the existence of interproximal papilla; the periodontal/peri-implant biotype (phenotype) was not correlated with the presence or absence of papilla, as well as the shape of the dental/prosthetic crown.

Survival of Dental Implants in the Cleft Area-A Retrospective Study

Objective To evaluate the survival rate of dental implants placed in the cleft area Design Retrospective study Setting Hospital for Rehabilitation of Craniofacial Anomalies, Brazil Institutional Tertiary Healthcare Center Patients 120 patients who received dental implants in the grafted cleft area in the years 1999 to 2005 Interventions Clinical data were evaluated from the records of 120 patients according to the following criteria placement grafted, cleft area, and age at surgery, age at placement of dental implants, site and dimension of implants, interval between placement of implants and the last clinical follow-up, and interval between placement and removal or indication for removal of implants Main Outcome Measures Percentage of survival rate of implants Results Mean age at placement of the bone graft was 17 6 years and 21 years at placement of implants A total of 123 cleft areas received secondary bone graft and bone graft to install implants (regraft) The mean survival rate was 34 months since placement of the implant to the last clinical follow-up and 26 months since placement of the prosthesis Seven dental implants were removed The survival rate since placement to the last clinical follow-up was 94 3% Conclusion Rehabilitation of the cleft area with dental implants is a viable and secure alternative, with good prognosis

Cleft Palate Obturation With Branemark Protocol Implant-Supported Fixed Denture and Removable Obturator

A 41-year-old man with cleft palate presented with a wide dehiscence and missing teeth. Six implants had been placed for fabrication of an overdenture, which was unsatisfactory. A bar was waxed and cast for connection to the implants; precision attachments were placed laterally for retention. A fixed partial denture was fabricated, and milled crowns were fabricated at the molar region to provide a guiding plane for insertion of a removable palatal obturator. Good swallowing and speech outcomes were achieved. This technique provided functional and esthetic benefits, enhanced oral hygiene, and improved the psychological condition of the patient.

Caries-preventive Efficacy and Retention of a Resin-modified Glass lonomer Cement and a Resin-based Fissure Sealant: A 3-year Split-mouth Randomised Clinical Trial

Purpose: This prospective clinical trial compared the retention rate and caries-preventive efficacy of two types of sealant modalities over a 3-year period. Materials and Methods: Using a split-mouth randomised design, 1280 sealants were randomly applied on sound permanent second molars of 320 young patients aged between 12 and 16 years. Half of the teeth (n = 640) were sealed with a resin-modified glass ionomer cement (RMGIC) (Vitremer (TM), 3M ESPE) and the other half (n = 640) with a conventional light-cure, resin-based fissure sealant (LCRB) (Fluoroshield (R), Dentsply Caulk). Teeth were evaluated at baseline, 6-, 12-, 18-, 24-, 30- and 36-month intervals with regard to retention and new caries development. Results: On the sealed occlusal surfaces after 3 years, 5.10% of RMGIC and 91.08% of LCRB sealants were totally intact and 6.37% of RMGIC and 7.65% of LCRB sealants were partially intact. New caries lesions were found in 20.06% of RMGIC sealed occlusal surfaces, compared to 8.91% for LCRB sealants. Conclusions: The findings of the present clinical study suggest that RMGIC should be used only as a transitional sealant that can be applied to newly erupting teeth throughout the eruptive process, whereas LCRB sealants are used to successfully prevent occlusal caries lesions once an effective rubber dam can be achieved. It can be concluded that there are differences between the RMGIC and LCRB sealants over a 3-year period in terms of the retention rate and caries-preventive efficacy. RMGIC can serve as a simple and economic sealing solution, however provisional. Due to its poor retention rate, periodic recalls are necessary, even after 6 months, to eventually replace the lost sealant.