Cleidocranial dysplasia: importance of radiographic images in diagnosis of the condition.

Cleidocranial dysplasia (CCD) is a rare syndrome usually caused by an autosomal dominant gene, although 40% of cases of CCD appear spontaneously with no apparent genetic cause. This condition is characterized by several cranial malformations and underdevelopment, absence of the clavicles, and multiple supernumerary and impacted permanent teeth. The diagnosis of this condition is usually based on the presence of the main features (supernumerary teeth, partial or total absence of one or both the clavicles, and bony malformations) and on clinical and familial evidence. The bony and dental features of CCD may be visualized on radiographic images of the face and skull. Here, we present a familial case of CCD and discuss the importance of dental radiographs in diagnosis of the condition.

Rapid molecular diagnosis of tuberculosis and other mycobacteriosis in smear-negative clinical specimens

Delay in diagnosis of pulmonary and other forms of tuberculosis (TB) can be fatal, particularly in HIV-infected patients. Hence, techniques based on nucleic acid amplification, which are both rapid and of high specificity and sensitivity, are now widely used and recommended for laboratories that diagnose TB. In the present study, diagnostic methods based on mycobacterial DNA amplification were evaluated in comparative trials alongside tradicional bacterial methods, using negative smear samples from patients with clinically-suspected TB (sputum samples from 25 patients with suspected pulmonary TB, urine samples from two patients with suspected renal TB and cerebrospinal fluid samples from one patient with suspected meningeal TB). A specificity of 100% was achieved with DNA amplification methods and tradicional culture/identification methods, in relation to clinical findings and treatment results. For the smear-negative sputa, conventional PCR for M. tuberculosis was positive in 62% of suspected lung TB case, showing the same sensitivity as bacterial identification. Both techniques failed in the detection of extra-pulmonary samples. Nested PCR showed, after species-specific amplification, a sensitivity of 100% for M. avium and 85% for M. tuberculosis. For extra-pulmonary smear-negative samples, only Nested PCR detected M. tuberculosis and all cases were confirmed clinically. Nested PCR, in which two-step amplification reactions are performed, can identify the two most important mycobacteria in human pathology quickly and directly from clinical spicimens.

Gingival margin alterations and the pre-orthodontic treatment amount of keratinized gingiva

The purpose of this retrospective study was to associate the amount of keratinized gingiva present in adolescents prior to orthodontic treatment to the development of gingival recessions after the end of treatment. The sample consisted of the intra-oral photographs and orthodontic study models from 209 Caucasian patients with a mean age of 11.20 ± 1.83 years on their initial records and 14.7 ± 1.8 years on their final records. Patients were either Angle Class I or II and were submitted to non-extraction orthodontic treatment. Gingival recession was evaluated by visual inspection of the lower incisors and canines as seen in the initial and final study models and intra-oral photographs. The amount of recession was quantified using a digital caliper and the observed post-treatment gingival margin alterations were classified as unaltered, coronal migration of the gingival margin or apical migration of the gingival margin. The width of the keratinized gingiva was measured from the mucogingival line to the gingival margin on the pre-treatment photographs. The teeth that developed gingival recession and those that did not have their gingival margin position changed did not differ in relation to the initial amount of keratinized gingiva (3.00 ± 0.61 and 3.5 ± 0.86 mm, respectively). Paradoxically, teeth that presented a coronal migration of the gingival margin had a smaller initial amount of keratinized gingiva (2.26 ± 0.31 mm). The mean amount of initial keratinized gingiva did not predispose lower incisors and canines to gingival recession.

Efficacy of ultrasonic, electric and manual toothbrushes in patients with fixed orthodontic appliances

Objective: This crossover study compared the efficacy of an ultrasonic toothbrush for the reduction of plaque, gingival inflammation, and levels of Streptococcus mutans, in relation to an electric and a manual toothbrush. Materials and Methods: Twenty-one patients with orthodontic appliances were divided into three groups. All patients were evaluated by a periodontist and samples of saliva were collected for quantification of S mutans. The patients received their first brushes with appropriate instructions. For each crossover leg, patients used each toothbrush for a period of 30 days. At the end of each washout period, participants received a periodontal evaluation and new samples of saliva were collected. After 15 days of using their own toothbrushes, patients received the next toothbrushes in the experimental sequence. Results: The ultrasonic brush group presented significant improvement in the reduction of visible plaque on the buccal surfaces (-6.36%, P = .007). The counts of S mutans decreased in the electric (2.04 × 105 to 1.36 × 105 colony-forming units [CFU]/mL) and ultrasonic (2.98 × 105 to 1.84 × 105 CFU/mL) groups. There were no statistical differences among the three brushes for the clinical and microbiological parameters evaluated. Conclusions: This study did not demonstrate that the ultrasonic toothbrush was better in reducing gingival inflammation in adolescent orthodontic patients, but plaque scores were lowered on buccal surfaces of teeth with orthodontic brackets. In addition, S mutans counts were markedly decreased in the electric and ultrasonic groups, which should be related to a reduced risk of oral disease. © 2006 by The EH Angle Education and Research Foundation, Inc.

Anticariogenic effect of fluoride-releasing elastomers in orthodontic patients

This in vivo experimental study evaluated the efficacy of fluoride-releasing elastomers in the control of Streptococcus mutans levels in the oral cavity. Forty orthodontic patients were recruited and divided into two groups of 20. Fluoride-releasing elastomeric ligature ties (Fluor-I-Ties, Ortho Arch Co. Inc., USA) were used in the experimental group, and conventional elastomeric ligature ties (D. Morelli, Brazil), in the control group. Two initial samples of saliva were collected at a 14-day interval to determine the number of colony forming units (CFU) of Streptococcus mutans. Immediately after collecting the second sample, fluoride-releasing elastomeric ligature ties were placed in the patients of the experimental group, and conventional ligature ties, in the patients of the control group. Seven, 14 and 28 days after placement of the elastomeric ligature ties, saliva and plaque surrounding the orthodontic appliance were collected for microbiologic analysis. There were no significant differences in the number of Streptococcus mutans CFUs in saliva or plaque in the area surrounding the fluoride-releasing or conventional elastomeric ligature ties. Thus, fluoride-releasing elastomeric ligature ties should not be indicated to reduce the incidence of enamel decalcification in orthodontic patients. Since there was no significant reduction in S. mutans in saliva or plaque, other means of prevention against enamel decalcification should be indicated for these patients.

Information for the diagnosis and treatment of root resorption due to tooth replantation.

A favorable prognosis after tooth avulsion depends on some variables, such as the extra-alveolar period and storage medium. Vitality of the periodontal ligament cells is considered a critical factor for a successful outcome without root resorption. The dental surgeon is provided with clinical information and radiographic findings to establish a diagnosis and may rely on current available guidelines. Once trauma has occurred, treatment must be quick and effective, and periodic follow-up must be performed. Clinical, radiographic, and histologic characteristics for each type of root resorption due to tooth replantation are presented, with the aim to provide information for the diagnosis and treatment of healing complications.

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.

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.

Oral lichen planus versus oral lichenoid reaction: Difficulties in the diagnosis

Lichen planus (LP) is a mucocutaneous disease with well-established clinical and microscopic features. The oral mucosa and skin may present clinical and microscopic alterations similar to those observed in LP, called lichenoid reactions (LRs), which are triggered by systemic or topical etiological agents. The difficulties faced to establish the differential diagnosis between the two pathologies were investigated in the literature. It was observed that the etiology of LP is still under discussion, with a tendency to self-immunity, while the etiology of LRs is related to the contact with specific agents, such as metallic restorative materials, resins, and drugs, allowing the establishment of a cause-effect relationship. In this case, the disease is caused by the antigen fixation in the epithelial cells, which are destructed by the immune system. Based on these data, protocols are suggested for this differentiation. The important role played by the integration between the clinician and the oral pathologist in the diagnostic process is highlighted. The treatment of LP comprises mainly the utilization of corticosteroids and the LR is treated by removal of the causal factor. Differentiation between the two diseases allows an effective and correct therapeutic approach.

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.

Shear bond strength of orthodontic brackets bonded using halogen light and light-emitting diode at different debond times

The aim of this in vitro study was to compare the photoactivation effects of QTH (Quartz-Tungsten-Halogen) and LED (Light-Emitting Diode) on the SBS (Shear Bond Strength) of orthodontic brackets at different debond times. Seventy-two bovine lower incisors were randomly divided into two groups according to the photoactivation system used (QTH or LED). The enamel surfaces were conditioned with Transbond self-etching primer, and APC (Adhesive Pre-Coated) brackets were used in all specimens. Group I was cured with QTH for 20 s and Group II with LED for 10 s. Both groups were subdivided according to the different experimental times after bonding (immediately, 24 h and 7 days). The specimens were tested for SBS and the enamel surfaces were analyzed according to the Adhesive Remnant Index (ARI). The statistical analysis included the Tukey's test to evaluate the main effects of photoactivation and debond time on SBS. The Chi-square test was used to compare the ARI values found for each group, and no statistically significant difference was observed. The debond time of 7 days for QTH photoactivation showed statistically greater values of SBS when compared to the immediate and 24 h periods. There was no statistically significant difference between the QTH and LED groups immediately and after the 24 h period. In conclusion, bonding orthodontic brackets with LED photoactivation for 10 s is suggested because it requires a reduced clinical chair time.

Knowledge on dental trauma and orthodontic tooth movement held by a group of orthodontists

The objective of this work was to assess the knowledge about orthodontic tooth movement and dental trauma held by a group of orthodontists in specific areas of Brazil. For this purpose, 166 questionnaires with 15 objective questions about this subject were distributed. One hundred and five questionnaires were properly filled and collected after 30 days. It was concluded that, except for avulsion, the knowledge on dental injuries held by the professionals interviewed was considered unsatisfactory, and about 40% of them were not acquainted with the recommendations for the orthodontic movement of traumatized teeth.

Composite pontics for orthodontic patients with extraction spaces.

Esthetic orthodontic appliances continue to appeal to more patients, which results in objections to extraction spaces that remain for several months during orthodontic therapy. This has led orthodontists to design temporary pontics that fill extraction sites and that can be reduced as the spaces close. This report describes a simple, efficient, and expeditious technique for making such pontics. © 2010 Quintessence Publishing Co, Inc.

Effect of toothbrushing with different manual toothbrushes on the shear bond strength of orthodontic brackets

The aim of this study was to evaluate the effect of brushing with a Colgate 360° or Oral B Indicator 35 toothbrush on the shear bond strength of orthodontic brackets bonded to extracted human teeth. The bristle wear and bristle tip morphology were also examined after simulated tooth-brushing. Orthodontic brackets (Roth-P/1 st and 2 nd pre-molar S/D- Slot 0.18) were bonded (Transbond XT ®) to the smoothest surface of each of 45 extracted human molar and premolar teeth. Test specimens were randomly divided into three groups: Group 1, control group with no brushing; Group 2, brushing with the Oral B Indicator 35; Group 3, brushing with the Colgate 360°. Samples were adapted to a machine that simulated tooth-brushing. The bond strength of each bracket to each tooth was assessed with a mechanical testing machine. The bristle wear and bristle tip morphology indices were also assessed. Statistically significant differences were defined for p ≤ 0.05. The average bond strengths (range: 90.18-90.89 kgf/cm 2) did not differ among the three groups. The Colgate 360° showed less bristle wear and a better bristle tip morphology than the Oral B Indicator 35 toothbrush. However, use of either toothbrush did not decrease the bond strength of the orthodontic brackets. Therefore, patients undergoing orthodontic therapy can safely use either toothbrush.

Sistemas de pensiones de América Latina, diagnóstico y alternativas de reforma. Estudios de caso de América Latina y el Caribe: conclusiones y recomendaciones, Santiago 3-5 diciembre 1990 y 22-23 agosto 1991 = Pension systems in Latin America: diagnosis and reform alternatives. Case studies in Latin America and the Caribbean: conclusions and recommendations, Santiago, 3-5 December 1990 and 22-23 August 1991

Documentos presentados a dos seminarios realizados en la Sede de CEPAL en Santiago entre el 3 y 5 de diciembre de 1990 y el 22 y 23 de agosto de 1991