Lower intercanine width and gingival margin changes. A retrospective study.

OBJECTIVE: To determine if changes in the lower intercanine widths during orthodontic treatment with fixed appliances result in gingival margin changes around the lower canines and incisors. METHOD: Pre- and post-treatment intra-oral photographs and orthodontic study models of 178 Caucasian adolescents (101 female, 77 male) were used. All subjects were treated with fixed appliances. The subjects had mean ages of 11.41 (SD: 1.83) years and 14.91 (SD: 1.78) years on their initial and final records respectively. The latter were taken 28 days or more after the appliances had been removed. The inclusion criteria were: Angle Class I or Class II malocclusion (with or without transverse and/or vertical discrepancies); nonextraction treatment; less than 4 mm crowding or spacing; fully erupted lower incisors and good periodontal health. The intercanine widths and the positions of the gingival margins relative to the maximum curvatures of the labial surfaces of the lower canines and incisors were measured with digital calipers. RESULTS: A significant association was found between unaltered intercanine widths and coronal migration of the gingival margins (p = 0.045). There were no significant associations between either increased or reduced intercanine widths and changes in the gingival margins. CONCLUSIONS: Following orthodontic treatment coronal migration of the gingival margins around the lower incisors and canines is more likely to be associated with an unaltered intercanine width.

Divine proportions and facial esthetics after manipulation of frontal photographs.

AIM: To investigate the relationship between divine proportion and facial esthetics in frontal photographs as well as whether any of the 4 ratios for manipulation provide more favorable facial esthetics. MATERIAL AND METHODS: The sample comprised 20 frontal photographs of Caucasian individuals (11 males and 9 females). The photographs were digitized and stored on a compact disk. A photometric analysis was created with 7 facial segments that were measured on Image Tool software and 4 ratios between 2 facial segments calculated using Microsoft Excel. This manipulation led to 5 different photographs of the same individual: one photograph with no manipulation and the others with 1 of the ratios manipulated in the Deformer 2.0 to very close or equal to 1.618. Thereafter, the 5 photographs of all individuals were evaluated by 12 examiners. The examiners selected those photographs that were esthetically more pleasant. CONCLUSION: After evaluation, a chi-square test revealed a relationship between divine proportion and facial esthetics. Among the ratios selected, R1 and R2 provided more favorable facial esthetics.

Ossificação da sutura palatina mediana após o procedimento de expansão rápida da maxila: Estudo radiográfico

Objective: the current study aims at following up radiographically the evolution of the midpalatal suture during the expansion procedure since the opening of the suture until bone formation. Methods: the sample comprised 38 patients in the mixed dentition stage submitted to the rapid palatal expansion protocol of the Hospital for Rehabilitation of Craniofacial Anomalies. Results: it was observed an individual variation on the period of bone ossification of the midpalatal suture, which justifies the radiographic follow-up as determinant for the appliance removal. Due to long-term post-treatment stability, the expander should be removed after the new suture is completely formed. Conclusions: the findings show that it is necessary more than three months for the complete reorganization of the midpalatal suture during the passive phase of the rapid palatal expansion.

Ajuste oclusal na Ortodontia: Por que, quando e como?

Introduction: The knowledge of dental occlusion should be considered the basic foundation to an excellent orthodontic practice. The patient's diagnose without the centric relation assessment can take the orthodontist to an unpleasant surprises. The use of rectangular archwires requires occlusal contacts been checked to decide what kind of the dental movement will be necessary to achieve the dental equilibrium and mainly to investigate if the movement will be possible. Considering the occlusal surfaces complexity, the occlusal adjustment by selective grinding should be performed during the orthodontic treatment to allow vertical dental movements reducing treatment's time. Occlusal interferences are responsible not only for biomechanics adverse effects, producing undesirable dental movements, but also for potential side effects such as excessive forces (occlusal trauma), leading to roots reabsorption. The occlusal adjustment is a determinant point on dental balance after the end of orthodontics treatments, where each posterior occlusal tooth contacts A and B, or B and C on buccolingual aspect, as well as the stoppers and equalizers contacts on mesiodistal direction must be achieved and well established. The appropriate role of anterior teeth in mandibular movements must be determined, allowing immediate disclusion of posterior teeth, known as anterior guide, and promoting protecting muscle forces to the stomatognathic system. Selective grinding should not be used. in place of well planned and executed orthodontic movement. Aim: The aim of this article is to present the rationale use of occlusal adjustment in Orthodontics.

Occurrence, extension, and severity of gingival margin alterations after orthodontic treatment.

To assess the occurrence, extension, and severity of gingival margin alterations in a sample of youth after orthodontic treatment. Records from 209 Caucasian adolescents (118 female and 91 male) before and after orthodontic treatment were selected. Patients presented a mean age at the beginning of orthodontic treatment of 11.20 ± 1.86 years and a final mean age of 14.72 ± 1.83 years. Class I and II patients with mandibular incisors and canines that were completely erupted and with spacing or crowding not exceeding 4 mm were evaluated. The presence of gingival recession on the labial surface of the mandibular anterior teeth was evaluated in intraoral photographs and casts made before and after treatment. The proportion of patients with gingival recession after treatment was statistically higher than at the beginning (P<.001). After orthodontic treatment, gingival recession was not present in any of the teeth for 63.6% of the patients; in 29.2% of the patients, recession was present in at least 1 tooth. In terms of severity, the majority of affected teeth (47%) presented gingival recession less than 2 mm and in 2% more than 4 mm. It may be concluded that alterations in the gingival margin, especially gingival recession, occur in patients after orthodontic therapy, but the extent and severity of this finding are low. COPYRIGHT © 2007 BY QUINTESSENCE PUBLISHING CO, INC.

Orthognathic Surgery in the Young Cleft Patient: Preliminary Study on Subsequent Facial Growth

Purpose: This study evaluated the long-term effects of orthognathic surgery on subsequent growth of the maxillomandibular complex in the young cleft patient. Patients and Methods: We evaluated 12 young cleft patients (9 male and 3 female patients), with a mean age of 12 years 6 months (range, 9 years 8 months to 15 years 4 months), who underwent Le Fort I osteotomies, with maxillary advancement, expansion, and/or downgrafting, by use of autogenous bone or hydroxyapatite grafts, when indicated, for maxillary stabilization. Five patients had concomitant osteotomies of the mandibular ramus. All patients had presurgical and postsurgical orthodontic treatment to control the occlusion. Radiographs taken at initial evaluation (T1) and presurgery (T2) were compared to establish the facial growth vector before surgery, whereas radiographs taken immediately postsurgery (T3) and at longest follow-up (T4) were used to determine postsurgical growth. Each patient's lateral cephalograms were traced, and 16 landmarks were identified and used to compute 11 measurements describing presurgical and postsurgical growth. Results: Before surgery, all patients had relatively normal growth. After surgery, cephalograms showed statistically significant growth changes from T3 to T4, with the maxillary depth decreasing by -3.3° ± 1.8°, Sella-nasion-point A by -3.3° ± 1.8°, and point A-nasion-point B by -3.6° ± 2.8°. The angulation of the maxillary incisors increased by 9.2° ± 11.7°. Of 12 patients, 11 showed disproportionate postsurgical jaw growth. Maxillary growth occurred predominantly in a vertical vector with no anteroposterior growth, even though most patients had shown anteroposterior growth before surgery. The distance increased in the linear measurement from nasion to gnathion by 10.3 ± 7.9 mm. Four of 5 patients operated on during the mixed dentition phase had teeth that erupted through the cleft area. A variable impairment of postoperative growth was seen with the 2 types of grafting material used. No significant difference was noted in the effect on growth in patients with unilateral clefts versus those with bilateral clefts. The presence of a pharyngeal flap was noted to adversely affect growth, whereas simultaneous mandibular surgery did not. After surgery, 11 of 12 patients tended toward a Class III end-on occlusal relation. Conclusions: Orthognathic surgery may be performed on growing cleft patients when mandated by psychological and/or functional concerns. The surgeon must be cognizant of the adverse postsurgical growth outcomes when performing orthognathic surgery on growing cleft patients with the possibility for further surgery requirements. Performing maxillary osteotomies on cleft patients would be more predictable after completion of facial growth. © 2008 American Association of Oral and Maxillofacial Surgeons.

La technique de l’arc segmenté. Contrôle de l’ancrage et modification significative du profil facial : une étude de cas

This article evaluates space closure mechanics efficiency in an extraction case where maximum anchorage was a requirement. The Segmented Arch Technique (SAT) was utilized as an anchorage control strategy to obtain maximum anterior retraction and, in consequence, significant facial profile change. A 20-year-10-month old woman needed severe labial and profile changes. The patient had four premolars extracted and SAT with type A mechanics [1] (Marcotte [2] activation protocol) was applied. The results showed significant reduction in labial protrusion and incisal angulation with effective anchorage control. The results were compared to others available in the literature derived from different techniques, where anterior retraction was also accomplished with maximum anchorage [3-7]. In conclusion, the SAT with type A mechanics has been shown to be another treatment option when significant changes in the soft-tissue profile are needed in extraction cases. © 2008. CEO. Published by Elsevier Masson SAS. All rights reserved.

Avaliação da inclinação do incisivo inferior através da tomografia computadorizada

Introduction: Orthodontics has always used lateral cephalometric radiographs (LC) as the main examination in the orthodontic diagnosis and treatment plan. The determination of incisor position is part of most cephalometric analysis, including Tweed analysis. However, all radiographic images have limitations, since it is a bidimensional image of a tridimensional structure and overlapping of bone and dental structures often occurs. Computed tomography (CT) allows a trustworthy diagnostic, mainly for its tridimensional images possibility. In this situation it seems reasonable to question the classic cephalometric analysis, creating factors of comparison with computed tomography data. Aim: For this, it was considered the evaluation of the angle between the long axis of the inferior incisor and the mandibular plane (IMPA) in the lateral cephalograph and in the computed tomography. Methods: Nineteen patients, selected for orthodontic treatment, had constituted the sample of this study, 12 female and 7 male, with ages between 16 years and 4 months and 28 years and 2 months. After the collection of data made by two examiners, statistical analyses for the attainment of the errors intra and inter-examiners had been made, using level of significance of 5%. Results and Conclusion: It was concluded that IMPA can be measured in the lateral cephalometric radiographs with trustworthiness, even that its values were smaller when compared with the computed tomography.

Uprighting impacted mandibular second molars with orthodontic elastic separating rings.

A 16-year-old girl presented with complaints of recurrent spontaneous pain in the mandibular second molar region. Treatment favored use of a simple uprighting technique involving orthodontic elastic separating rings.

Valores Referenciais para Procedimentos Odontológicos (VRPO) em Ortodontia

Introduction: The cost of orthodontic treatment is a very important issue. The aim of this study was to analyze the current Indicative Values for Dental Procedures (IVDP) for orthodontic procedures. Methods: Laws, dental entities papers and scientific literature were utilized. Results: Laws are too general and only offer abstract parameters when define remunerations. Current IVDP vary in the same State, according to the consultant entity. Dental entities interpret that general clinicians can practice Corrective Orthodontics, but new scientific studies begin to question this understanding. The Brazilian Association of Orthodontics and Dentofacial Orthopedics (ABOR) suggests that IVDP for orthodontic specialty must be formulated. Conclusion: Current IVDP are not standardized and are below the correct values for orthodontic procedures, because they are the mean of general clinicians and orthodontists remunerations; and ABOR is legally and ethically supported to claim specific IVDP for orthodontic specialty.

Comparison of the shear bond strengths of conventional mesh bases and sandblasted orthodontic bracket bases

This study aimed to compare in vitro the shear bond strength between metallic brackets (Abzil) with conventional mesh bases and metallic brackets with bases industrially sandblasted with aluminum oxide using three adhesive systems, in order to assess the influence of sandblasting on adhesiveness and to compare 3 different bonding systems. Two hundred and forty bovine incisors were used and randomly divided into 6 groups (40 teeth in each group), according to the bracket base and to the bonding system. The brackets were direct-bonded in bovine teeth with 3 adhesive systems: System A - conventional Transbond™ XT (3M -Unitek); System B - Transbond™ Plus Self Etching Primer + Transbond™ XT (3M - Unitek) and System C - Fuji ORTHO LC resin-reinforced glass ionomer cement in capsules (GC Corp.). Shear bond strength tests were performed 24 hours after bonding, in a DL-3000 universal testing machine (EMIC), using a load cell of 200 kgf and a speed of 1 mm/min. The results were submitted to statistical analysis and showed no significant difference between conventional and sandblasted bracket bases. However, comparison between the bonding systems presented significantly different results. System A (14.92 MPa) and system C (13.24 MPa) presented statistically greater shear bond strength when compared to system B (10.66 MPa). There was no statistically significant difference between system A and system C.

Integrated clinical treatment of gingival recession secondary to root perforation: case report.

Among the factors that influence the success of treatment of a root perforation, its location and possibility of contamination are determinant because the interaction of these 2 factors may result in significant periodontal injury. The management of cases of hard-to-reach contaminated perforations depends on the choice of an adequate technique. In the case reported in this article, controlled orthodontic tooth extrusion was successfully performed to treat gingival recession secondary to root perforation. The outcomes showed that this technique preserves the zone of attached gingiva, maintains the crown height, and prevents the involvement of the supporting bone tissue. The favorable clinical and radio?graphic conditions after 7 years of follow-up demonstrate the viability of this treatment approach.

A practical method for lingual retainer fixation before direct bonding: Clinical suggest

The retention phase is initiated after orthodontic treatment completion to prevent orthodontic relapse. There are several techniques, direct and indirect, available for placing bonded lingual retainers, but none of them is considered as a standard clinical protocol. The best choice should be the association of simplicity and efficiency. This article presents a practical method sequence for fixation of the lingual retainer before direct bonding. © 2009 Elsevier Ltd and the Japanese Orthodontic Society.

Incontinentia pigmenti presenting as hypodontia in a 3-year-old girl: A case report

Introduction. Incontinentia pigmenti or Bloch-Sulzberger syndrome is a rare X-linked dominant disease that mainly affects the skin, eyes, hair, central nervous system and teeth. The disease is predominant among women. Although dermatologic manifestations are among the most important aspects for the diagnosis of the syndrome, they are less damaging to the patient and do not require treatment. However, oral involvement characterized by hypodontia of deciduous and permanent teeth is important for the diagnosis and treatment of the patient. Case presentation. We report the case of a 3-year-old girl with ophthalmologic and neurologic disturbances, cutaneous manifestations and hypodontia. Since the patient did not present more damaging manifestations such as neurologic and/or ophthalmologic problems, her most severe complications were related to dental anomalies. The importance of integrated dental treatment, which combines pediatric dentistry, orthodontics and conventional prosthesis, is emphasized. Conclusion. Hypodontia is a frequent finding in incontinentia pigmenti, and dentists should be aware of this condition in order to help with the diagnosis. © 2009 Kitakawa et al; licensee BioMed Central Ltd.