Cephalometric evaluation of the predictability of bimaxillary surgical-orthodontic treatment outcomes in long face pattern patients: a retrospective study

OBJECTIVE: The aim of this study was to compare by means of McNamara as well as Legan and Burstone's cephalometric analyses, both manual and digitized (by Dentofacial Planner Plus and Dolphin Image software) prediction tracings to post-surgical results. METHODS: Pre and post-surgical teleradiographs (6 months) of 25 long face patients subjected to combined orthognathic surgery were selected. Manual and computerized prediction tracings of each patient were performed and cephalometrically compared to post-surgical outcomes. This protocol was repeated in order to evaluate the method error and statistical evaluation was conducted by means of analysis of variance and Tukey's test. RESULTS: A higher frequency of cephalometric variables, which were not statistically different from the actual post-surgical results for the manual method, was observed. It was followed by DFPlus and Dolphin software; in which similar cephalometric values for most variables were observed. CONCLUSION: It was concluded that the manual method seemed more reliable, although the predictability of the evaluated methods (computerized and manual) proved to be reasonably satisfactory and similar.

Surgical-orthodontic tractio for impacted maxillary canines: a critical review and suggested protocol

Maxillary canine impaction is a common occurrence, especially in the palate, despite sufficient space in the arch for tooth alignment. A proper approach requires knowledge of different specialties of dentistry, such as orthodontics, surgery, radiology, and periodontology, which are generally not centered on a single professional. The causes for canine impaction may be either generalized or localized, and the diagnosis should be made through specific clinical and radiographic examination. The prognosis of surgical-orthodontic treatment depends on the position of the canine in relation to the neighboring teeth and height of the alveolar process, in addition to careful surgical technique, considering that there are risks involved, such as ankylosis, loss of tooth vitality, root resorption of the involved tooth and adjacent teeth, and damage to supporting tissues. Given the important role played by impacted maxillary canines, their traction is the treatment of choice in orthodontically treated patients. The present study reviews the literature on important factors to be considered when approaching impacted canines, such as therapeutic possibilities, their advantages and disadvantages.

A comparison of apical root resorption after orthodontic treatment with surgical exposure and traction of maxillary impacted canines versus that without impactions.

SUMMARY BACKGROUND/OBJECTIVES Orthodontic management of maxillary canine impaction (MCI), including forced eruption, may result in significant root resorption; however, the association between MCI and orthodontically induced root resorption (OIRR) is not yet sufficiently established. The purpose of this retrospective cohort study was to comparatively evaluate the severity of OIRR of maxillary incisors in orthodontically treated patients with MCI. Additionally, impaction characteristics were associated with OIRR severity. SUBJECTS AND METHODS The sample comprised 48 patients undergoing fixed-appliance treatment-24 with unilateral/bilateral MCI and 24 matched controls without impaction. OIRR was calculated using pre- and post-operative panoramic tomograms. The orientation of eruption path, height, sector location, and follicle/tooth ratio of the impacted canine were also recorded. Mann-Whitney U-test and univariate and multivariate linear mixed models were used to test for the associations of interest. RESULTS Maxillary central left incisor underwent more OIRR in the impaction group (mean difference = 0.58mm, P = 0.04). Overall, the impaction group had 0.38mm more OIRR compared to the control (95% confidence interval, CI: 0.03, 0.74; P = 0.04). However, multivariate analysis demonstrated no difference in the amount of OIRR between impaction and non-impaction groups overall. A positive association between OIRR and initial root length was observed (95% CI: 0.08, 0.27; P < 0.001). The severity of canine impaction was not found to be a significant predictor of OIRR. LIMITATIONS This study was a retrospective study and used panoramic tomograms for OIRR measurements. CONCLUSIONS This study indicates that MCI is a weak OIRR predictor. Interpretation of the results needs caution due to the observational nature of the present study.

Surgical adjunctive procedures for accelerating orthodontic treatment

BACKGROUND A range of surgical and non-surgical techniques have received increasing attention in recent years in an effort to reduce the duration of a course of orthodontic treatment. Various surgical techniques have been used; however, uncertainty exists in relation to the effectiveness of these procedures and the possible adverse effects related to them. OBJECTIVES To assess the effects of surgically assisted orthodontics on the duration and outcome of orthodontic treatment. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 10 September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8), MEDLINE via OVID (1946 to 10 September 2014), EMBASE via OVID (1980 to 10 September 2014), LILACS via BIREME (1980 to 10 September 2014), metaRegister of Controlled Trials (to 10 September 2014), ClinicalTrials.gov (to 10 September 2014), and the World Health Organization (WHO) International Clinical Trials Registry Platform (to 10 September 2014). We checked the reference lists of all trials identified for further studies. There were no restrictions regarding language or date of publication in the electronic searches. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating the effect of surgical adjunctive procedures for accelerating tooth movement compared with conventional treatment (no surgical adjunctive procedure). DATA COLLECTION AND ANALYSIS At least two review authors independently assessed the risk of bias in the trials and extracted data. We used the fixed-effect model and expressed results as mean differences (MD) with 95% confidence intervals (CI). We investigated heterogeneity with reference to both clinical and methodological factors. MAIN RESULTS We included four RCTs involving a total of 57 participants ranging in age from 11 to 33 years. The interventions evaluated were corticotomies to facilitate orthodontic space closure or alignment of an ectopic maxillary canine, with the effect of repeated surgical procedures assessed in one of these studies. The studies did not report directly on the primary outcome as prespecified in our protocol: duration of orthodontic treatment, number of visits during active treatment (scheduled and unscheduled) and duration of visits. The main outcome assessed within the trials was the rate of tooth movement, with periodontal effects assessed in one trial and pain assessed in one trial. A maximum of just three trials with small sample sizes were available for each comparison and outcome. We assessed all of the studies as being at unclear risk of bias.Tooth movement was found to be slightly quicker with surgically assisted orthodontics in comparison with conventional treatment over periods of one month (MD 0.61 mm; 95% CI 0.49 to 0.72; P value < 0.001) and three months (MD 2.03 mm, 95% CI 1.52 to 2.54; P value < 0.001). Our results and conclusions should be interpreted with caution given the small number of included studies. Information on adverse events was sought; however, no data were reported in the included studies. AUTHORS' CONCLUSIONS This review found that there is limited research concerning the effectiveness of surgical interventions to accelerate orthodontic treatment, with no studies directly assessing our prespecified primary outcome. The available evidence is of low quality, which indicates that further research is likely to change the estimate of the effect. Based on measured outcomes in the short-term, these procedures do appear to show promise as a means of accelerating tooth movement. It is therefore possible that these procedures may prove useful; however, further prospective research comprising assessment of the entirety of treatment with longer follow-up is required to confirm any possible benefit.

Orthodontic treatment of a midline diastema related to mesiodens and thumb-sucking habit

OBJETIVO: A associação de mesiodens com hábito de sucção digital como fatores etiológicos de diastemas medianos é uma situação clínica incomum e, quando presente, provoca um comprometimento estético e funcional. O objetivo desse trabalho é descrever o caso clínico de um paciente, aos 9 anos de idade, com mordida aberta anterior e um diastema mediano de 9 mm. DESCRIÇÃO do CASO: Após o diagnóstico ortodôntico, a conduta terapêutica foi a exodontia do mesiodens e instalação de uma grade palatina fixa para controle do hábito de sucção digital. em seguida, bráquetes ortodônticos foram colados nos incisivos centrais superiores e o diastema foi fechado possibilitando a irrupção espontânea dos incisivos laterais. Quando adequados níveis de trespasse vertical e horizontal entre os incisivos foi alcançado e o hábito removido, o tratamento foi finalizado. CONCLUSÃO: É importante ressaltar que com o objetivo de alcançar resultados estéticos e funcionais satisfatórios, minimizando sequelas ao desenvolvimento da oclusão deve-se realizar o diagnóstico precoce e intervenção imediata dos diastemas medianos patológicos.

Efficacy of high intensity diode laser as an adjunct to non-surgical periodontal treatment: a randomized controlled trial

The high intensity diode laser has been studied in periodontics for the reduction of subgingival bacteria in non-surgical treatment. Our study evaluated the bacterial effect as well as changes in periodontal clinical parameters promoted by root scaling and planing associated with this wavelength. Twenty-seven patients randomly assigned in two groups underwent root scaling and planing on the tested sites, and only the experimental group received the diode laser irradiation. Among the clinical parameters studied, the clinical probing depth (CPD) and the clinical attachment level (CAL) resulted in significant enhancement in the control group when compared with the experimental group (P = 0.014 and P = 0.039, respectively). The results were similar for both groups regarding the plaque index (PI) and bleeding on probing (BP). No significant difference in the microbiological parameters was observed between the control and experimental groups. It was possible to conclude that the high power diode laser adjunct to the non-surgical periodontal treatment did not promote additional effects to the conventional periodontal treatment.

Histological evaluation of experimentally induced subluxation in rat molars and its implications on the management of orthodontic treatment

The purpose of this study was to evaluate the histological alterations occurred in the periradicular region of rat molars after intentional subluxation using an experimental method to induce dentoalveolar trauma. Eighteen adult male Wistar rats (Rattus norvegicus albinus) were selected for the study. The dentoalveolar trauma was experimentally induced by the application of an occlusogingival force on the occlusal surface of the maxillary right first molar using a tensiometer secured on a fully articulated support with adjustable steel shafts. The animals were assigned to six groups (n = 3), according to the intensity of the force applied to induce trauma: Group I (GI, control) - no force application; Groups II-VI (GII-GVI) - the animals were subjected to 600, 700, 800, 900 and 1000 cN force, respectively. After experimental induction of trauma, the animals were sacrificed by anesthetic overdose and the right maxillas were removed and processed for histological analysis under light microscopy. In the animals of GII, GIII and GIV, the histological alterations were similar to those described for GI. GVI (1000 cN) presented the most severe alterations, with the occurrence of buccal bone plate fracture, alveolar fracture and root fracture, which are not present in mild traumatic injuries like subluxation. The 900 cN force (GV) was capable to produce clinical and histological alterations in the gingival and periodontal tissues compatible with those observed in subluxation.

Pre-Prosthetic Orthodontic Treatment Using Personalized Elastic Separators for Optimization of Emergence Profile in Esthetic Crowns: A Clinical Report

Restoring a misaligned tooth with an inadequate contact point is a challenge to the practitioner. In some instances, teeth that could be repositioned and adequately restored are extracted. Thus, the aim of this article was to describe a treatment using orthodontic and prosthetic techniques to restore esthetics and function in a patient with a distally drifted maxillary lateral incisor. The patient's functional and esthetic expectations were successfully met with the outlined treatment.

Enamel microabrasion followed by dental bleaching for patients after orthodontic treatment - Case reports

This article reports clinical procedures used to remove residual bonded resin and enamel stains following bracket debonding at the conclusion of orthodontic treatment. A water-cooled fine-tapered diamond bur was used for resin removal, followed by enamel surface finishing using a commercially available microabrasion paste. It was noted that residual tooth coloration remained yellowish because of enamel translucency; the yellow dentin shade showed through. Additional tooth shade lightening was achieved using carbamide peroxide dental bleaching solution in custom-formed trays. This report describes a safe and effective technique that optimizes tooth appearance at the conclusion of orthodontic therapy. Mechanical resin removal, enamel microabrasion, and tooth bleaching are employed.