Adilson Luiz Ramos

Perceptions of laypersons and orthodontists regarding the buccal corridor in long- and short-face individuals

OBJECTIVE To determine the perception of orthodontists and laypersons regarding the size of the dark spaces in the buccal corridors and how that affects smile esthetics in individuals with long and short faces. MATERIALS AND METHODS Images of eight smiling individuals were modified to create five sizes of dark spaces in the buccal corridors (2%, 10%, 15%, 22%, and 28%) and were submitted to a group of laypersons and a group of orthodontists. RESULTS Laypersons were more critical in their evaluation than orthodontists. Laypersons could not distinguish the gradation of dark spaces in the buccal corridor unless it was very plain. Orthodontists perceived this gradation beginning at 15%. Female evaluators were more critical than male evaluators in both groups. CONCLUSIONS The presence or absence of dark spaces in the buccal corridors has little influence over smile esthetics. While this aspect must be considered in the orthodontic diagnosis, there is no justification for expanding the buccal corridor to eliminate dark spaces unless they are very evident.

Avaliação do perfil dos profissionais da área de Ortodontia quanto às condutas legais

OBJECTIVE: to evaluate the legal actions and behavior in the doctor/patient relationship, as used by Dental Surgeons practicing Orthodontics. METHODS: the population sample of the present study consisted of dental surgeons, active in the area of Orthodontics, and registered with Editora Dental Press - Maringa/PR, with a total sample size of 525 professionals. The research was conducted using a 17-question survey geared to these professionals. RESULTS AND CONCLUSIONS: the majority of participants in our study are specialized in Orthodontics; 75% of professionals use some sort of contract at the office/clinic; 73.7% of professionals periodically request maintenance x-rays; a large percentage of professionals (58.9%) keep patient records on file for life. The surveyed professionals demonstrate good knowledge of the Code of Ethics in Orthodontics, especially of Chapter XIV - on Communication.

Low-level laser therapy effects on pain perception related to the use of orthodontic elastomeric separators

INTRODUCTION: Some patients refer to pre-banding orthodontic separation as a painful orthodontic procedure. Low-level laser therapy (LLLT) has been reported to have local analgesic effect. OBJECTIVE: The aim of this single-blind study was to investigate the perception of pain caused by orthodontic elastomeric separators with and without a single LLLT application (6J). METHODS: The sample comprised 79 individuals aged between 13 and 34 years old at orthodontic treatment onset. Elastomeric separators were placed in first maxillary molars at mesial and distal surfaces and kept in place for three days. The volunteers scored pain intensity on a visual analogue scale (VAS) after 6 and 12 hours, and after the first, second and third days. One third of patients received laser applications, whereas another third received placebo applications and the remaining ones were controls. Applications were performed in a split-mouth design. Thus, three groups (laser, placebo and control) were assessed. RESULTS: No differences were found among groups considering pain perception in all periods observed. CONCLUSION: The use of a single-dose of LLLT did not cause significant reduction in orthodontic pain perception. Overall pain perception due to orthodontic separator placement varied widely and was usually mild.

What is gold standard and what is ground truth

Clinical decision-making is complex and based upon accurate evaluation of clinical findings using di -agnostic tests and reference standard data. Given that many aspects of dental examination are not direct measures, but rely on indirect measures, it is impor-tant for clinicians to understand the basic principles and terms used to assess the accuracy of diagnostic tests and to appropriately evaluate published litera-ture regarding these tests. Luckily, there is a variety of readily available metric systems to assess the quality of diagnostic test studies and to help clinicians better understand evidence-based literature. Dentistry, or shall we say Clinical Dentistry, is be -coming more complex and patients have been better informed. Importantly, health care has also shifted focus to emphasize evidence-based practice (EBP). EBP is considered the gold standard for health profes -sional decision-making. No one can deny that the ac -tivities in the field of evidence-based Dentistry have grown exponentially in the last decade. However, we cannot forget that Pierre Fauchard (1678- 11761) may have been the first to warn the dental field about the concept of evidence, taking into consideration the practices of the time. Fauchard and James Lind (1716-1790) were both concerned about the health of sailors dying of scurvy and, for this reason, con-ceptualized a “clinical trial” involving the use of vi-tamin C to counteract the disease. The former even tested techniques for the removal of caries, dental restoration and implants.The true meaning of evidence-based Dentistry is grounded in a solid understanding and application of clinical epidemiology principles to reduce any confusion that may exist due to academic training. Epidemiology is defined as the “Science of making predictions about individual patients or a group, by recounting clinical events in similar patients in order to ensure that the predictions are correct”. Clinical epidemiology is “a subfield that applies the princi-ples and methods of epidemiology to study the oc-currence and outcomes of disease in people with a given illness”.

Interdisciplinary treatment for a patient with open-bite malocclusion and amelogenesis imperfecta

Amelogenesis imperfecta (AI) comprises a clinically and genetically heterogeneous group of conditions that affect the dental enamel, occasionally in conjunction with other dental, oral, and extraoral tissues. The aim of this case report is to describe an interdisciplinary treatment of hypoplastic AI associated with a severe open bite. The treatment consisted of surgical, orthodontic, periodontal, prosthetic and restorative management, establishing good chewing function, dental esthetics and facial harmony.

Effects of palatal crib and bonded spurs in early treatment of anterior open bite: A prospective randomized clinical study

OBJECTIVE To evaluate the overbite correction of fixed palatal crib (FPC) and bonded lingual spur (BLS) in the early treatment of anterior open bite (AOB) in mixed dentition (primary outcome) as well as its influence on dental and skeletal cephalometric measurements (secondary outcome). MATERIALS AND METHODS The selected patients had AOB and a mean age of 8.23 years. They were divided into the following three groups by casting lots: control (n  =  13), palatal crib (n  =  13), and spur (n  =  13). Data from the lateral teleradiography was obtained at the beginning, at 6 months, and after 1 year. The cephalometric analysis was performed by Cef-X program, recording the values of SNA, SNB, ANB, SnG oGn, 1.PP, IMPA, nasolabial angle, overbite, and overjet. Intergroup and intragroup comparisons were obtained via one-way analysis of variance. RESULTS The degree of AOB was similar at baseline (P > .05). At 6 months and then after 1 year all groups showed improvement in the overbite. However, only the crib and spur groups showed positive overbite. No cephalometric measurements changed significantly over the period analyzed. CONCLUSIONS We conclude that the FPC and BLS are simple and effective for the treatment of anterior open bite, with the advantage given to the FPC.

Class III treatment using facial mask: Stability after 10 years

Early Class III malocclusion treatment may not have long-term stability due to mandibular growth. Although some features of this malocclusion point to a better prognosis, it is practically impossible for the orthodontist to foresee cases that require new intervention. Many patients need retreatment, whether compensatory or orthodontic-surgical. The present study reports the case of a Class III patient treated at the end of the mixed dentition with the use of a face mask followed by conventional fixed appliances. The case remains stable 10 years after treatment completion. It was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as a requirement for the title of certified by the BBO.

Comparação de parâmetros periodontais após utilização de contenção convencional 3x3 plana e contenção modificada

AIM: the purpose of the present study was to compare periodontal indexes after the use of two types of bonded fixed retainers: conventional 3x3 plain retainer (orthodontic wire 0.8mm, bonded to the canine teeth only) and the modified retainer (0.6mm multi strand wire, allowing free access to dental floss and bonded to all anterior teeth). METHODS: a test group of fifteen patients used the conventional retainer for 6 months. After a two week interval, the modified retainer was used for another 6 months. Previous to each phase, the patients went through tooth scaling, root planing and oral hygiene orientation. At the end of each phase the dental plaque index, gingival index and dental calculus index were evaluated. Furthermore, the calculus accumulation along the retainer wire was measured and all patients answered a questionnaire about the use, acceptance and comfort of both types of retainers. RESULTS AND CONCLUSIONS: the scores for the plaque and gingival indexes were higher for the modified retainer (p<0.05) in the lingual and proximal surfaces. The same occurred with the calculus index in the proximal surfaces (p<0.05). The calculus along wire index also scored higher (p<0.05) for the modified retainer. All patients described the use of the conventional retainer as being more comfortable. Therefore, it was concluded that the conventional retainer is a better treatment choice than the modified retainer.

Effect of alendronate sodium on tooth movement in ovariectomized rats

OBJECTIVES The aim of the present study was to evaluate the effect of two different dosages of alendronate on induced orthodontic movement in an experimental model involving rats with osteoporosis following ovariectomy. DESIGN Female Wistar rats (Rattus norvegicus) eight weeks of age were divided into four groups (n=12/group): ovariectomized (OVX group); ovariectomized and treated with alendronate sodium at 1mg/kg (Group OVX+ALN1); ovariectomized and treated with alendronate sodium at 2mg/kg (Group OVX+ALN2); and sham operated (control). Three months after ovariectomy, the maxillary right first molar was submitted to movement for five and seven days. After the death of the animals, the maxilla were removed and processed for microscopic evaluation. The maxillary left first molar (without movement) was used for comparison purposes in all groups. The samples were processed for the quantification of alveolar bone and tooth movement. RESULTS Intragroup comparisons showed significant movement after five and seven days (p<0.05) for all groups. Comparison among groups revealed greater tooth movement in the OVX group (p<0.05), on day 7. CONCLUSIONS Both alendronate sodium doses similarly decreased tooth movement in ovariectomized rats (p>0.05). Movement in ovariectomized+alendronate groups were also smaller than non-ovariectomized rats, however without statistical difference.

Correlação entre a densidade óssea mandibular, femural, lombar e cervical

INTRODUCTION: Due to the rise in frequency of adult patients who currently are submitted to orthodontic treatment, general health conditions of this age have been a reason of inquiries correlated to events related to bone metabolism, as dental movements are dependent on the process of bone remodeling, even though in a local level. Different standards of bone density can give different answers to the orthodontic movement. AIM: The present study evaluated the correlation of the general bone mineral density (BMD) to the mandibular region. METHODS: Therefore, 22 healthy women aged between 30 and 45 years old were selected for bone densitometry examinations of lumbar, cervical, femoral, as well as mandibular alveolar region. The correlations to these readings were tested as well as values of reference were established for cervical and mandibular areas. RESULTS: The results did not demonstrate significant correlation among the mandibular density to the others studied areas. There was only significant correlation between cervical and femural region. Normal BMD average value for mandibular region was 0.983g/cm2 (SD = 0.334), whereas for cervical region was 0.768g/cm2 (SD = 0.102), and the average values for lumbar and femoral regions were respectively 1.127g/cm2 (SD = 0.067) and 0.925g/cm2 (SD = 0.078), these last ones were similar to the reference values of World Health Organization (WHO). CONCLUSIONS: It is suggested that the examination of the femoral area can comprehend the expected value to cervical area, however particular densitometry examination for the mandibular area is needed, and the exploration of the traditional values (lumbar and femoral) is not appropriate to the estimative of this area. Additional studies are necessary to evaluate local density variations and its influence on orthodontic movement.