Percepção dos auxiliares odontológicos na clínica ortodôntica quanto aos seus limites de atuação profissional

INTRODUÇÃO: numa época em que o mercado odontológico exige que os serviços prestados possuam qualidade diferenciada, a utilização adequada de profissionais auxiliares constitui uma ferramenta importantíssima para se obter aumento de produtividade no consultório. Para tanto, a correta utilização dessa ferramenta exige que a equipe auxiliar seja tecnicamente capacitada e envolvida num ambiente onde as funções delegadas estejam fundamentadas nos preceitos éticos e nas bases legais que regem a profissão. OBJETIVO: identificação do perfil técnico da equipe auxiliar, analisando-se a percepção destes profissionais quanto ao seu papel nas atividades pertinentes à clínica ortodôntica, com base na legislação vigente. METODOLOGIA: o presente levantamento foi desenvolvido com base num questionário aplicado a todos os profissionais que auxiliam diretamente os ortodontistas regularmente inscritos no CRO-GO, que atendem nas cidades de Goiânia e Aparecida de Goiânia (GO), no período de maio a julho de 2003. RESULTADOS E CONCLUSÕES: verificou-se que diversos procedimentos não estabelecidos nas normas que regem a delegação de funções em Odontologia estão sendo executados pela equipe auxiliar, demonstrando que o conteúdo dessa legislação está sendo ignorado ou descumprido.

Sobremordida exagerada: diagnóstico e estratégias de tratamento

A sobremordida exagerada é um tipo de má oclusão que apresenta etiologia multifatorial e necessita de um diagnóstico diferencial elaborado e específico. O objetivo desse artigo é descrever os principais elementos de diagnóstico facial, cefalométrico e dentário e as principais estratégias de tratamento, como a extrusão de dentes posteriores, a intrusão de dentes anteriores ou a combinação dessas. Serão apresentados seis casos clínicos, auxiliando o ortodontista no diagnóstico e na seleção da estratégia de tratamento individualizada para cada situação clínica.

Treatment effects produced by the Bionator appliance. Comparison with an untreated Class II sample

The purpose of this retrospective investigation was to evaluate the dentoalveolar and skeletal cephalometric changes of the Bionator appliance on individuals with a Class II division 1 malocclusion. Lateral cephalograms of 44 patients were divided into two equal groups. The control group comprised 22 untreated Class II children (11 males, 11 females), with an initial mean age of 8 years 7 months who were followed without treatment for a period of 13 months. The Bionator group (111 males, 11 females) had an initial mean age of 10 years 8 months, and were treated for a mean period of 16 months. Lateral cephalometric headfilms were obtained of each patient and control at the beginning and end of treatment.The results showed that there were no changes in forward growth of the maxilla in the experimental group compared with the control group. However, the Bionator treatment produced a statistically significant increase in mandibular protrusion, and in total mandibular and body lengths. There were no statistically significant differences in craniofacial growth direction between the Bionator group and the control group, although the treated patients demonstrated a greater increase in posterior face height. The Bionator appliance produced labial tipping of the lower incisors and lingual inclination of the upper incisors, as well as a significant increase (P < 0.01) in mandibular posterior dentoalveolar height. The major effects of the Bionator appliance were dentoalveolar, with a smaller significant skeletal effect. The results indicate that the correction of a Class II division 1 malocclusion with the Bionator appliance is achieved not only by a combination of mandibular skeletal effects, but also by significant dentoalveolar changes.

Maxillary canine-first premolar transposition - Restoring normal tooth order with segmented mechanics

Tooth transpositions present at a relatively low incidence in the world population and primarily affect maxillary canines and premolars. Treatment of this disturbance should take into account aspects such as facial pattern, age, malocclusion, tooth-size discrepancy, stage of eruption, and magnitude of the transposition. Mechanics for correction should be entirely individualized, reducing the risks and adverse effects. Practitioners often select simpler options, indicating extraction of permanent teeth, which is an irreversible procedure that may bring about damages to the patient. This study presents a case report and treatment of unilateral transposition of maxillary canine and premolar with repositioning of affected teeth to their respective normal positions.

Mandibular skeletal growth and modelling between 10 and 15 years of age

This study pertains to a random sample of untreated French-Canadian adolescents (79 females and 107 males) evaluated at 10 and again at 15 years of age. Superimpositions on natural reference structures were performed to describe condylar growth and modelling of 11 mandibular landmarks. Superimpositions on natural cranial/cranial base reference structures were performed to describe mandibular displacement and true rotation.The results showed significant superior and posterior growth/modelling of the condyle and ramus. Males underwent significantly (P < 0.01) greater condylar growth and ramus modelling than females. With the exception of point B, which showed significant superior drift, modelling changes for the corpus landmarks were small and variable. The mandible rotated forward 2-3.3 degrees and was displaced 9.6-12.7 mm inferiorly and 1.9-2.7 mm anteriorly. Individual differences in ramus growth and modelling, both amount and direction, can be explained by mandibular rotation and displacements. Multivariate assessments revealed that superior condylar growth and ramus modelling were most closely associated with forward rotation and inferior mandibular displacement. Posterior growth and modelling were most closely correlated with anterior mandibular displacement and forward rotation. Modelling of the lower anterior border was independent of rotation and displacement.

Panoramic evaluation of mesiodistal axial inclinations of maxillary anterior teeth in orthodontically treated subjects

The objectives of this study were to evaluate, through panoramic radiographs, the mesiodistal axial inclinations of the maxillary anterior teeth at the beginning and end of nonextraction orthodontic treatment, and to compare the results with the mesiodistal axial inclinations of a control sample with normal (acceptable) occlusions. Methods: the experimental sample consisted of 40 white patients (20 male, 20 female; mean age, 14 years) with Class I maloccusions who were treated orthodontically with a standard edgewise (not preadjusted) technique without extractions. The mean treatment period was 1.6 years. The control sample comprised 42 white subjects (14 male, 28 female; age range, 12-17 years) with untreated normal (acceptable) occlusions. Panoramic radiographs were taken of the patients at the beginning (T1) and end (T2) of treatment. The mean values of the mesiodistal axial inclination at T1 were compared with the mean values at T2, and both were compared with the mesiodistal axial inclinations of the control sample. Results- the mesiodistal axial inclinations of the maxillary anterior teeth of the experimental group at T1 were different from those of the control group for 50% of the evaluated teeth. In contrast, the inclinations at T2 were consistent with the normal anatomical configuration of the controls. Conclusions: the panoramic radiograph is an effective tool for evaluating the mesiodistal axial inclinations of maxillary anterior teeth.

Head, eye and arm coordination in table tennis

The aim of this study was to determine the role of head, eye and arm movements during the execution of a table tennis forehand stroke. Three-dimensional kinematic analysis of line-of-gaze, arm and ball was used to describe visual and motor behaviour. Skilled and less skilled participants returned the ball to cued right or left target areas under three levels of temporal constraint: pre-, early- and late-cue conditions. In the pre- and early-cue conditions, both high and low skill participants tracked the ball early in flight and kept gaze stable on a location in advance of the ball before ball-bat contact. Skilled participants demonstrated an earlier onset of ball tracking and recorded higher performance accuracy than less skilled counterparts. The manipulation of cue condition showed the limits of adaptation to maintain accuracy on the target. Participants were able to accommodate the constraints imposed by the early-cue condition by using a shorter quiet eye duration, earlier quiet eye offset and reduced arm velocity at contact. In the late-cue condition, modifications to gaze, head and arm movements were not sufficient to preserve accuracy. The findings highlight the functional coupling between perception and action during time-constrained, goal-directed actions.

Comparative study of the Frankel (FR-2) and bionator appliances in the treatment of Class II malocclusion

The purpose of this investigation was to compare the dentoalveolar and skeletal cephalometric changes produced by the Frankel (FR-2) and bionator appliances in persons with Class 11 malocclusion. Lateral cephalograms were available for 66 patients of both sexes, who were divided into 3 groups of 22. The control group included untreated Class 11 children, with an initial mean age of 8 years 7 months; they were followed without treatment for 13 months. The FR-2 appliance group had an initial mean age of 9 years; those children were treated for a mean period of 17 months. The bionator group initially had a mean age of 10 years 8 months; on average, they were treated for 16 months. The results demonstrated no significant changes in maxillary growth during the evaluation period. Both appliances showed statistically significant increases in mandibular growth and mandibular protrusion, with greater increases in patients treated in the bionator group. Both experimental groups showed an improvement in the maxillomandibular relationship. There were no significant changes in growth direction, while the bionator group had a greater increase in posterior facial height. Both appliances produced similar labial tipping and protrusion of the lower incisors, lingual inclination, retrusion of the upper incisors, and a significant increase in mandibular posterior dentoalveolar height. The major treatment effects of bionator and FR-2 appliances were dentoalveolar, with a smaller, but significant, skeletal effect.

Transverse skeletal base adaptations with Bionator therapy: A pilot implant study

The purpose of this randomized, controlled trial was to evaluate transverse skeletal base adaptations to Bionator therapy. The sample included 25 patients (15 male, 10 female) aged 6.9 to 11.2 years with Class II Division 1 malocclusion. The patients were randomly allocated to either a control (n = 11) or treatment (n = 14) group and followed longitudinally for approximately 12 months. Treatment consisted of a Bionator only, constructed to remain approximately 2 mm from the buccal dentition. Transverse maxillary and mandibular changes were evaluated cephalometrically according to 4 bilateral maxillary and 2 bilateral mandibular implants. Untreated Class II controls exhibited significant increases between posterior maxillary implants but no significant changes between the anterior maxillary or mandibular implants. There were no significant width differences between the control and treated groups before treatment. Posterior maxillary implant widths increased significantly (P < .05) in both groups, but the treated group showed significantly greater width increases than the control group. The treated group also showed greater increases between mandibular implants, but the differences were not statistically significant. These results suggest that transverse skeletal base adaptations occur as a result of Bionator therapy.

Influence of surgical repositioning of mature permanent dog teeth following experimental intrusion: a histologic assessment

The aim of this study was to evaluate, through histologic examination, the effect of surgical repositioning of intruded dog teeth upon the pulpal and surrounding tissues. Thirty teeth in 10 adult dogs, aged 2-3 years, were used. Fifteen teeth were intruded, surgically repositioned and fixed using orthodontics wire, composite resin, and enamel acid conditioning. All these teeth served as the experimental group. The remaining intruded teeth were not treated ( control group). The animals were sacrificed to allow observations at 7,15, and 30 post-operative days. The maxillary and mandibular archs were removed and processed for histologic exam. Based on the methodology and observed results, we concluded that: pulpal necrosis, external root resorption and ankylosis were common sequelae to severe traumatic intrusion; a careful immediate surgical repositioning of severed intruded permanent tooth with complete root formation has many advantages with few disadvantages.

Comparative in vitro study of the shear bond strength of brackets bonded with restorative and orthodontic resins

The aim of this study was to evaluate the shear bond strength of brackets bonded with different restorative systems and compare it with that afforded by an established orthodontic bonding system. Seventy human bicuspids were used, divided into five different groups with 14 teeth each. Whereas a specific orthodontic bonding resin (Transbond (TM) XT) was used in the control group, the restorative systems Charisma, Tetric Ceram, TPH Spectrum and Z100 were used in the other four groups. Seven days after bonding the brackets to the samples, shear forces were applied under pressure in a universal testing machine. The data collected was evaluated using the ANOVA test and, when a difference was identified, the Tukey test was applied. A 5% level of significance was adopted. The mean results of the shear bond strength tests were as follows: Group 1 (Charisma), 14.98 MPa; Group 2 (Tetric Ceram), 15.16 MPa; Group 3 (TPH), 17.70 MPa; Group 4 (Z100), 13.91 MPa; and Group 5 or control group (Transbond (TM) XT), 17.15 MPa. No statistically significant difference was found among the groups. It was concluded that all tested resins have sufficient bond strength to be recommended for bonding orthodontic brackets.

Tooth separation: A risk-free procedure?

This article reports the case of a 12-year-old patient with tooth extrusion, pain, gingival bleeding, and localized periodontitis near the maxillary second premolar. Despite probing and radiographic examination, it was not possible to establish the etiology. Tooth extraction was indicated because of the severe tooth mobility and extrusion. Curettage of the tooth socket revealed a rubber separator. Preventive approaches are suggested to avoid iatrogenesis and legal problems. (Am J Orthod Dentofacial Orthop 2012; 142:402-5)

Changes over time in canine retraction: An implant study

Introduction: The objective of this study was to analyze rates of canine movement over the first 2 months of continuous retraction, when rate changes are expected. Methods: Ten patients with bone markers placed in the maxilla and the mandible had their canines retracted over a 2-month period. Retraction was accomplished with beta-titanium alloy T-loop springs. Standardized 45 degrees oblique cephalograms where taken initially and every 28 days thereafter. The radiographs were scanned and digitized twice (the average was used for the analyses). The radiographs were superimposed by using the bone markers and oriented on the functional occlusal plane. Paired t tests were used to compare side and jaw effects. Results: There were no significant differences between sides. The maxillary cusp was retracted 3.2 mm, with less movement during the first (1.1 mm) than during the second 4 weeks (2.1 mm). The maxillary apices did not move horizontally. There were no significant vertical movements in the cusps and apices of the maxillary canines. The mandibular cusp was retracted 3.8 mm-1.1 mm during the first and 2.7 mm during the second 4 weeks. The mandibular apices were protracted 1.1 mm. The cusps and apices were intruded 0.6 and 0.7 mm, respectively. The only difference between jaws was the greater protraction of the mandibular apices during the second 4 weeks and in overall movement. Conclusions: The rate of canine cusp retraction was greater during the second than the first 4 weeks. The mandibular canines were retracted by uncontrolled tipping whereas the maxillary canines were retracted by controlled tipping. (Am J Orthod Dentofacial Orthop 2009; 136: 87-93)

Midsymphyseal distraction osteogenesis: A new alternative for the treatment of dental crowding

In this article, we describe a midsymphyseal distraction osteogenesis treatment with a novel dentally supported appliance. This approach differs from that used in previous reports because the incisors were allowed to move during the distraction procedure. This report shows that midsymphyseal distraction osteogenesis can be used to expand both arches to produce a wider smile. Borderline cases can be treated with this technique without the compromising effects commonly observed with conventional therapy. (Am J Orthod Dentofacial Orthop 2009;135:530-5)