Tratamento da classe II divisão 2 com aparelho de Herbst após o pico de crescimento puberal

Patients with Class II division 2 malocclusion and mandibular retrusion have limited treatment options after the growth peak, such as surgical-orthodontic treatment or mandibular advancement devices. Among bite-jumping devices, the Herbst appliance allows greater increase of mandibular growth since it does not require patient compliance and allows continuous use. This case report presents the treatment of a Class II division 2 malocclusion in a patient after growth peak, performed in two stages. The first stage included the upper incisors proclination and overjet increase with multibracket appliance to benefit next stage. The second stage involved mandibular advancement using Herbst appliance aiming to correct the Class II molar relationship. The treatment resulted in a stable occlusion with periodontal health, normal functions and facial aesthetics improvement. Dental and skeletal changes arising from treatment could be assessed by cephalometric analysis and superimposition of pretreatment and post-treatment cephalometric tracings. Antero-posterior discrepancy was corrected by means of dental movement as well as by mandibular growth increment stimulated by the Herbst appliance.

Avaliação das dimensões e relacionamento dos arcos dentários após tratamento com Bionator de Balters

The deficiency of data in the literature took us to evaluate the Bionator of Balters appliance in the alterations of the dimensions and the relationship of the dental archs in children with malocclusion Class II, division 1 of Angle. The experimental group was constituted by 36 pairs cast Caucasians patients, aged between 7 years and 10 months - 11 years and 8 months, being 10 females and 8 males. The Levene´s test showed statistical evidences of likeness among the groups. Statistical analysis was preceded and showed significant alterations (p < 0,005) in the variable indicatives of maxillary first molars' distance, overjet, upper arch total length, upper arch anterior length, right molar relationship, left molar relationship, right canine relationship and left canine relationship. On the other hand, there wasn't significant alteration related to the lower arch and maxillary intercanines distance. The Balters' Bionator appliance had a favorable effect in the improvement of the correction of the malocclusion in Class II (foremost in molars and canines relationship) and transversal increase of the upper arch, mainly in the posterior area of arch.

Extração de incisivo inferior: uma alternativa no tratamento da classe III

The correction of a Class III malocclusion in adult patients is one of the major challenges in orthodontics due to facial deformities occurring during the unfavorable growth of this kind of pattern, as well as the treatment options capable of producing facial changes aesthetically acceptable and adequate for today's beauty standards. One acceptable alternative treatment is the removal of a lower incisor. For a Class III correction through a lower incisor extraction a thorough analysis and planning must be carried out by taking into consideration the amount of overjet and overbite, periodontal condition of the teeth and the possibility of obtaining a good dental occlusion with acceptable facial aesthetics. Will be presented two case reports of patients presenting an anteroinferior crowding, Class III malocclusion condition. The treatment through a lower incisor extraction and the reasons why this treatment was adopted will be discussed.

Necessidade de ancoragem do grupo A e o controle biomecanico da mola T pré-ativada por curvatura para o fechamento de espacos

Contemporary orthodontics has sought, beyond the esthetic, occlusal and functional goals, treatments even faster and with less visits to the orthodontist — especially in patients that require dental extractions in which the generated space becomes a nuisance. The segmented arch technic (SAT), by the use of a "T" loop spring, has provided such results within these requirements. Therefore, this study aimed to appraise and demonstrate the confection, activation and biomechanical control of "T" loop spring, in the group with high anchorage necessity (group A), for retraction of anterior teeth; as well as to present a case report, with high anterior retraction necessity, treated with "T" loop spring.

Tratamento ortodôntico lingual individualizado com o sistema Incognito

Introduction: The orthodontic treatment using lingual brackets has been desired by adult patients for esthetic factors. In this paper it is described the clinical steps of an orthodontic treatment using Incognito™ system, individualized lingual brackets and archwires designed by CAD/CAM technology. Methods: The presented case describes the treatment of a patient with mesofacial growth pattern,Class I malocclusion, with mandibular crowding and diastema between the upper central incisors, treated using 100% individualized lingual brackets. Results: After treatment, the molar relation of Class I was kept, the spaces between upper central incisors were closed and mandibular crowding corrected. Conclusion: This case report demonstrated the efficiency of the new method for lingual orthodontic treatment.

Effect of different bleaching protocols on dental enamel and composite resin

To evaluate changes in microhardness, roughness and surface morphology of dental enamel and composite resin after different tooth bleaching techniques. Material and Methods: Dental fragments from bovine incisors with composite resin restorations were submitted to different bleaching protocols: G1 – daily 8 hours application of a 10% carbamide peroxide (CP) gel during 21 days; G2: 3 applications of 15 minutes of a 38% hydrogen peroxide (H2O2) gel; G3: 38% H2O2 gel associated to irradiation with LED (470nm) during 6 minutes. The Knoop micro hardness of enamel and composite resin were evaluated at 1, 7, 14 and 21 days for G1, and after 1, 2 and 3 sessions for G2 and G3. The roughness and superficial morphology (atomic force microscopy) were evaluated before and at the end of the bleaching treatment. The data were analyzed by Mann-Whitney and Wilcoxon tests (=5%). Results: Significant reduction on enamel hardness was observed after 2 and 3 sessions for G2 and G3. For composite, the reduction occurred after 21 days for G1, and after 3 sessions for G2 and G3 (p<0.05). Significant reduction on roughness and superficial morphology were observed only for enamel of G1 group (p<0.05). Conclusion: The 10% CP gel promoted only superficial alterations on dental enamel, while the 38% H2O2 gel promoted mineral reduction of this dental tissue. All the bleaching protocols promoted reduction on hardness of composite resin.

Morphology and adhesion on blood components in root surfaces treated by a piezoelectric ultrasonic: an in vitro study

The aim of this study was to evaluate the morphology and adhesion of blood components on root surfaces instrumented with piezoelectric ultrasonic Piezon Master Surgery. Methods 10 teeth were used in this study. The teeth had their proximal divided into four areas that received different treatments: Group 1: untreated control Group 2: scaling with manual instrument; Group 3: scaling with ultrasound; Group 4: Scaling with manual instruments and ultrasound. We obtained 20 samples, 10 of which were used to analyze the morphology and the other 10 were used for analysis of adhesion of blood components. The specimens were analyzed by scanning electron microscopy. Photomicrographs were analyzed by the scores of adhesion of blood components and the index of root morphology. The results were statistically by the Kruskall-Wallis and Mann-Whitney with a significance level of 95%. Results The morphological analysis showed that the Group 1 had a surface unchanged in relation to other groups (Group 1 X Group 2 = 0.0025; Group 1 X Group 3 = 0.0003; Group 1 X Group 4 = 0.0003) and Group 2 presented a smoother surface compared to Group 1 and groups instrumented with ultrasound (Group 2 X Group 3 = 0.0025; Group 2 X Group 4 = 0.0025) there were no statistical differences between the Groups 3 and 4. analysis of adhesion of blood components showed that the Groups 2, 3 and 4 had no statistically significant differences between themselves, but more biocompatible surfaces promoted the surface untreated control (Group 1 X Group 2 = 0.02; Group 1 X Group 3 = 0.04; Group 1 X Group 4 = 0.005). Conclusion The instrumentation with piezoelectric ultrasonic promoted an irregular root surface, but did not negatively affect the adhesion of blood components.

Estudo cefalométrico comparativo dos traçados predictivos e resultados ortodôntico-cirúrgicos em pacientes com face longa

The purpose of this research was to compare, by cephalometric analysis (McNamara and Legan & Burstone) the predictive tracings (by methods manual, and by softwares Dentofacial Planner Plus and Dolphin Image) with the post surgical results. Were selected the pre and post surgical lateral telerradiograph (six months after orthognatic surgery) of the 25 long face patients treated with combined orthognatic surgery. Were made the prediction tracings for each method and comparing cephalometrically with the post surgical results. This protocol was repeated once more for the error method evaluation, and the statistical was made by variance analysis and Tuckey overtest. The results show more frequency of the cephalometric values' aproximation of the post surgical results when the manual method (50% of the similarity with the post surgical result), followed of the DFPlus (31,2%) and Dolphin (18,8%) softwares. The experimental condition permits to conclude that the manual method had more precision, although the previsibility of the digital methods was reasonable satisfactory.

Micro-arc oxidation as a tool to develop multifunctional calcium-rich surfaces for dental implant applications

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of Er:YAG laser and diamond drill on hybrid layer morphology obtained with self-etch adhesive: analysis by SEM and confocal laser scanning microscopy (CLSM)

This study aimed to evaluate the effect of Er:YAG (L) and diamond drills (DD) on: 1) the microshear bond strength (MPa); 2) the adhesive interface of two-step (TS) – Adper Scotchbond Multipurpose and one-step (OS) adhesives – Adper EasyOne, both from 3M ESPE. Material and methods: According to the preparation condition and adhesives, the samples were divided into four groups: DD_TS (control); DD_OS; L_TS and L_OS. 60 bovine incisors were randomly divided into experimental and groups: 40 for microshear bond strength (n = 10) and 20 for the adhesive interface morphology [6 to measure the thickness of the hybrid layer (HL) and length of tags (t) by CLSM (n = 3); 12 to the adhesive interface morphology by SEM (n = 3) and 2 to illustrate the effect of the instruments on dentine by SEM (n = 1)]. To conduct the microshear bond strength test, four cylinders (0.7 mm in diameter and 1 mm in height with area of adhesion of 0.38 mm) were constructed with resin composite (Filtek Z350 XT – 3M ESPE) on each dentin surface treated by either L or DD and after adhesives application. Microshear bond strength was performed in universal testing machine (EMIC 2000) with load cell of 500 kgf and a crosshead speed of 0.5 mm / min. Adhesive interface was characterized by thickness of hybrid layer (HL) and length of tags (t) in nm, with the aid of UTHSCSA ImageTool software. Results: Microshear bond strength values were: L_TS 34.10 ± 19.07, DD_TS 24.26 ± 9.35, L_OS 33.18 ± 12.46, DD_OS 21.24 ± 13.96. Two-way ANOVA resulted in statistically significant differences only for instruments (p = 0.047). Mann-Whitney identified the instruments which determined significant differences for HL thickness and tag length (t). Concerning to the adhesive types, these differences were only observed for (t). Conclusion: It can be concluded that 1) laser Er:YAG results in higher microshear bond strength values regardless of the adhesive system (TS and OS); 2) the tags did not significant affect the microshear bond strength; 3) the adhesive interface was affected by both the instruments for cavity preparation and the type of adhesive system used.

Musculoskeletal disorders in upper limbs in dental students: exposure level to risk factors

Aim: This study assessed the risk factors of undergraduate students to develop musculoskeletal disorders (MSD) in the upper limbs, regarding gender, type of dental clinical procedure, mouth region treated, and the four-handed dentistry practice. Methods: Dental students enrolled in the 8th semester in the Araraquara School of Dentistry, UNESP, Brazil, were photographed while practicing 283 dental procedures. The Rapid Upper Limb Assessment (RULA) method was used to evaluate the working postures of each student. The photographs were evaluated and a final risk score was attributed to each analyzed procedure. The prevalence of risk factors of developing MSD was estimated by point and by 95% confidence interval. The association between the risk factor of developing disorders and variables of interest were assessed by the chi-square test with a significance level of 5%. Results: The risk factors of developing MSD were high, regarding most dental procedures performed by the undergraduate students (score 5: 7.07%, CI95%: 4.08- 10.06%; score 6: 62.54%, CI95%: 56.90-68.18%). There was no significant association between the RULA final score and gender (p=0.559), and type of dental procedure (p=0.205), and mouth regions by arch (p=0.110) or hemi-arch (p=0.560), and the use of four-handed dentistry (p=0.366). Conclusions: It can be concluded that gender, type of dental clinical procedure, mouth region treated, and practice of four-handed dentistry did not influence the risk of developing MSD in the upper limbs among the dental students evaluated; however, they are at a high risk of developing such disorders.

Reabilitação estético-funcional sobre implantes agulhados e endósseos

This report shows the resolution of a case study whose aim was promote the aesthetic and functional rehabilitation of upper left hemi-arch over endosseous and needle implant prostheses. To improve the position of the needle implants, we performed the bucco-palatal bending of needles splinting them with composite resin; we removed the screwed implant prosthesis in the regions of the premolars (24 and 25) and molar (26). The mini-abutments of the last two implants were replaced, and in the first premolar and canine, we used cemented abutments due to implant angulation having planned soldering because of implant size and contact with one needle implant that could interfere with intimate contact bone/implant damaging biomechanics. Pick-up impressions were performed with an open tray, using a retractor cord in the needle implants and respective transfer copings. Therefore, models were related on semi-adjustable articulator after a face-bow recording and interocclusal indexes. After working cast fabrication and try-in of infra-structures, these were adjusted and related into the articulator again. Then, after ceramic build-up, adjustments, finishing, and torque, chemically-activated resin cement was applied on units 21 to 24. At the end of the case, we concluded that a good aesthetic and functional rehabilitation depends on thorough knowledge of techniques for each clinical situation.

Chemical and morphological features of dental composite resin: influence of light curing units and immersion media

Aims: The study evaluated the influence of light curing units and immersionmedia on superficial morphology and chemistry of the nanofilled composite resin Supreme XT (3M)through the EDX analysis and SEM evaluation. Light curing units with different power densitiesand mode of application used were XL 3000 (480 mW/cm2), Jet Lite 4000 Plus (1230mW/cm2), andUltralume Led 5 (790 mW/cm2) and immersion media were artificial saliva, Coke1, tea and coffee,totaling 12 experimental groups. Specimens (10 mm 3 2 mm) were immersed in each respectivesolution for 5 min, three times a day, during 60 days and stored in artificial saliva at 378C 6 18Cbetween immersion periods. Topography and chemical analysis was qualitative. Findings: Groupsimmersed in artificial saliva, showed homogeneous degradation of matrix and deposition of calciumat the material surface. Regarding coffee, there was a reasonable chemical degradation with loss ofload particles and deposition of ions. For tea, superficial degradation occurred in specific areaswith deposition of calcium, carbon, potassium and phosphorus. For Coke1, excessive matrix degra-dation and loss of load particles with deposition of calcium, sodium, and potassium. Conclusion:Light curing units did not influence the superficial morphology of composite resin tested, but theimmersion beverages did. Coke1affected material’s surface more than did the other tested drinks.Microsc. Res. Tech. 73:176–181, 2010.

Effects of immersion media and repolishing on color stability and superficial morphology of nanofilled composite resin

This study evaluated the influence of fluoride mouth rinses and repolishing on the superficial morphology and color stability of nanofilled resin. About 150 specimens were prepared and polished using aluminum oxide discs for 15 s with a pressure of 2 kg. The experimental groups were divided according to the immersion medium (artificial saliva, 0.5% sodium fluoride, Fluordent Reach, Oral B, Fluorgard) and repolishing procedure (without and with). The specimens were continuously immersed for 1 week. Thereafter, half of each sample was repolished. A color reading was performed after 24 h of immersion in the artificial saliva baseline, after continuous immersion, and after repolishing. The superficial morphology was examined using scanning electron microscopy (SEM) in a qualitative way. Color change (∆E) data were submitted to a mixed analysis of variance using a Shapiro-Wilk test (p>0.05 for the different immersion media) and Sidak's test (p<0.05 for the differences between groups). In the interaction between the repolishing and the immersion media, Fluorgard showed a statistical difference between the ∆E values with and without repolishing (p<0.0001). On the SEM observations, both Fluordent Reach and Fluorgard caused degradation of the superficial resinous matrix of the composite after continuous immersion. This matrix was removed after repolishing.

Spectrophotometric evaluation of dental bleaching under orthodontic bracket in enamel and dentin

Aware of the diffusion capacity of bleaching in the dental tissues, many orthodontists are subjecting their patients to dental bleaching during orthodontic treatment for esthetic purposes or to anticipate the exchange of esthetic restorations after the orthodontic treatment. For this purpose specific products have been developed in pre-loaded whitening trays designed to fit over and around brackets and wires, with clinical efficacy proven. Objective: The objective of this study was to evaluate, through spectrophotometric reflectance, the effectiveness of dental bleaching under orthodontic bracket. Material and Methods: Thirty-two bovine incisors crown blocks of 8 mm x 8 mm height lengths were used. Staining of tooth blocks with black tea was performed for six days. They were distributed randomly into 4 groups (1-home bleaching with bracket, 2- home bleaching without bracket, 3- office bleaching with bracket, 4 office bleaching without bracket). The color evaluation was performed (CIE L * a * b *) using color reflectance spectrophotometer. Metal brackets were bonded in groups 1 and 3. The groups 1 and 2 samples were subjected to the carbamide peroxide at 15%, 4 hours daily for 21 days. Groups 3 and 4 were subjected to 3 in-office bleaching treatment sessions, hydrogen peroxide 38%. After removal of the brackets, the second color evaluation was performed in tooth block, difference between the area under the bracket and around it, and after 7 days to verified color stability. Data analysis was performed using the paired t-test and two-way variance analysis and Tukey’s. Results: The home bleaching technique proved to be more effective compared to the office bleaching. There was a significant difference between the margin and center color values of the specimens that were subjected to bracket bonding. Conclusions: The bracket bond presence affected the effectiveness of both the home and office bleaching treatments.