Darcy Flávio Nouer

How may stressful experiences contribute to the development of temporomandibular disorders

Temporomandibular disorders (TMD) comprise the most common cause of chronic facial pain conditions, and they are often associated with somatic and psychological complaints including fatigue, sleep disturbances, anxiety, and depression. For many health professionals, the subjectivity of pain experience is frequently neglected even when the clinic does not find any plausible biologic explanation for the pain. This strictly biomedical vision of pain cannot be justified scientifically. The purpose of this study is to demonstrate, by original articles from the literature and recent studies conducted in our own laboratory, the biological processes by which psychological stress can be translated into the sensation of pain and contribute to the development of TMD. The role of the hypothalamic–pituitary–adrenal axis, the serotoninergic and opioid systems in the pathogenesis of facial pain is exposed, including possible future therapeutic approaches. It is hoped that knowledge from apparently disparate fields of dentistry, integrated into a multidisciplinary clinical approach to TMD, will improve diagnosis and treatment for this condition through a clinical practice supported by scientific knowledge.

Periodontal and microbiologic evaluation of 2 methods of archwire ligation: ligature wires and elastomeric rings.

INTRODUCTION Prophylactic programs to prevent dental biofilm accumulation must be implemented to minimize the risk for periodontal diseases in orthodontic patients. Therefore, we assessed the possible periodontal and microbiologic changes resulting from the use of 2 methods of orthodontic archwire ligation: elastomeric rings and steel ligatures. METHODS The following parameters were measured: plaque index, gingival bleeding index, probing depth, and biofilm samples from the maxillary second premolars and the mandibular lateral incisors were evaluated in 14 subjects without clinical signs of gingival inflammation before orthodontic appliance placement and after 6 months of treatment. Each orthodontic arch was fixed with elastomeric rings on 1 side of the midline, and steel ligatures were used on the opposite side. Polymerase chain reaction analysis was used to detect Porphyromonas gingivalis, Tannerella forsythia, Actinobacillus actinomycetemcomitans, Prevotella intermedia, and P nigrescens. RESULTS The elastomeric rings were associated with a higher score for plaque index and bleeding than steel ligatures, as well as many positive sites of T forsythia and P nigrescens (P <0.05). CONCLUSIONS Elastomeric rings favored these 2 periodontopathogens and harmed gingival conditions.

Evaluation of immunologic profile in patients with nickel sensitivity due to use of fixed orthodontic appliances.

The aim of this study was to develop a new approach to testing the impact of nickel antigen on in vitro cell-proliferation assay, to identify adverse reactions to casting alloys among orthodontic patients. Cell-proliferation assay in vitro was used as the basic methodology to assess the influence of such variables as source of nickel antigen, type of serum used to supplement the culture medium, and number of cells in the culture. We selected 35 orthodontic patients who were classified as nickel sensitive and non-nickel sensitive, based on their clinical records. Our results showed that hexahydrated nickel sulfate at 10 microg/mL, 10% of autologous sera, and 2 x 10(5) cells was the best condition for inducing the most marked nickel proliferation response in vitro. This optimized method was able to distinguish nickel-sensitive from non-nickel-sensitive dental patients and also to discriminate those with positive skin tests. Our data suggest that continuous exposure to nickel casting alloys might lead to oral tolerance mechanisms that modulate nickel sensitivity, as evidenced by the lower cell proliferation index in patients undergoing orthodontic treatment over 24 months. Finally, our findings demonstrated a known nickel-induced type 2 immune response and a marked lack of type 1 immunity (interferon gamma) as the hallmarks of nickel-sensitive patients. Further studies are needed to clarify the major cell phenotype associated with this type 2 immune response and the lack of type 1 immunity observed in nickel-sensitive people.

Shear bond strength of new and recycled brackets to enamel

The purpose of this study was to evaluate in vitro the shear bond strength of recycled orthodontic brackets. S2C-03Z brackets (Dental Morelli, Brazil) were bonded to the buccal surfaces of 50 extracted human premolars using Concise Orthodontic chemically cured composite resin (3M, USA). The teeth were randomly assigned to 5 groups (n=10), as follows. In group I (control), the bonded brackets remained attached until shear testing (i.e., no debonding/rebonding). In groups II, III and IV, the bonded brackets were detached and rebonded after recycling by 90-microm particle aluminum oxide blasting, silicon carbide stone grinding or an industrial process at a specialized contractor company (Abzil-Lancer, Brazil), respectively. In group V, the bonded brackets were removed and new brackets were bonded to the enamel surface. Shear bond strength was tested in an Instron machine at a crosshead speed of 0.5 mm/min. Data were analyzed statistically by ANOVA and Tukeys test at 5% significance level. There was no statistically significant difference (p>0.05) between the control brackets (0.52 kgf/mm2), brackets recycled by aluminum oxide blasting (0.34 kgf/mm2) and new brackets attached to previously bonded teeth (0.43 kgf/mm2). Brackets recycled by the specialized company (0.28 kgf/mm2) and those recycled by silicon carbide stone grinding (0.14 kgf/mm2) showed the lowest shear strength means and differed statistically from control brackets (0.52 kgf/mm2) (p<0.05). In conclusion, the outcomes of this study showed that bracket recycling using 90-microm aluminum oxide particle air-abrasion was efficient and technically simple, and might provide cost reduction for orthodontists and patients alike.

Effects of Short- and Long-Term Celecoxib on Orthodontic Tooth Movement

OBJECTIVE To test the hypothesis that short- and long-term celecoxib administration has no effect on orthodontic tooth movement. MATERIALS AND METHODS Male Wistar rats were submitted to short- (3 days) and long-term (14 days) celecoxib administration, while the respective control groups received equivolumetric saline intraperitoneal injections. The upper left first molars of all rats were moved mesially for 14 days by a fixed orthodontic appliance exerting 50 g force upon insertion. After the experimental period, tooth movement was quantified and tissues around the first molar were processed for tartrate-resistant acid phosphatase (TRAP) histochemistry. The amount of tooth movement and the number of TRAP-positive cells on the alveolar bone surface were evaluated. RESULTS The amount of tooth movement was significantly reduced in rats submitted to short- and long-term celecoxib administration, while the number of osteoclasts on the alveolar bone did not differ between the four groups studied. CONCLUSIONS The hypothesis is rejected. Although celecoxib administration did not affect the number of osteoclasts, the osteoclast activity might be reduced, which could explain the inhibition of tooth movement observed in the celecoxib-treated animals. These results indicate that orthodontists should be aware of patients under short- and long-term therapy with celecoxib.

Histological analysis of orthodontic root resorption in rats treated with the cyclooxygenase-2 (COX-2) inhibitor celecoxib

INTRODUCTION It has been reported that anti-inflammatory drugs used for treatment of pain and discomfort related to orthodontic treatment could slow down tooth movement. However, the effect of these drugs on orthodontic root resorption is not well understood. OBJECTIVES The aim of this study was to investigate whether the COX-2 inhibitor celecoxib offers some protection against orthodontically induced root resorption. DESIGN Male Wistar rats were divided into four groups: Groups I and II were treated with saline and celecoxib (10 mg / kg), respectively for 3 days. Groups III and IV were treated with saline and celecoxib for 14 days. The upper left first molars of all rats were moved mesially for 14 days with 50 g of force. An area including the disto-apical aspect of the mesial root of the first molar was processed for histological and histochemical techniques with tartarate-resistant acid phosphatase (TRAP). OUTCOME MEASURE The degree of root resorption was measured using an image analysis system with a grid-sheet superimposed in the root were resorption lacunae were counted. The number of TRAP-positive cells on the tooth root surface defined as odontoclasts were also evaluated. RESULTS The results revealed that there were no significant differences in the degree of root resorption and in the number of odontoclasts on the root between the four groups studied. CONCLUSION The short and long-term celecoxib administration did not suppress the root resorption in case of experimental orthodontic force application.

Enamel demineralization with two forms of archwire ligation investigated using an in situ caries model — a pilot study

A modified in situ model to assess enamel demineralization around orthodontic devices was developed and a pilot study was conducted to evaluate two types of archwire ligation. Enamel blocks were placed in palatal removable appliances where orthodontic brackets were bonded. The brackets on one side of the appliance were ligated with elastomeric rings and those on the other side with stainless steel wires. Four volunteers (two males, two females), mean age 27 years, wore the appliances for 14 days during which time a 20 per cent sucrose solution was dripped eight times a day onto the enamel blocks. The biofilm formed around the brackets was collected for microbiological analyses and the mineral loss around the brackets was determined by cross-sectional microhardness measurement. The ligatures evaluated did not differ significantly from each other regarding biofilm weight, total bacteria, total streptococci, mutans streptococci, or lactobacilli counts (P > 0.05, Wilcoxon paired test). Enamel demineralization was also not different around the brackets for the different ligation methods (P > 0.05, split-split-plot analysis of variance). However, a statistical power analysis based on the data showed a trend to higher demineralization around brackets ligated with elastomeric rings. The developed modified in situ model may be suitable to assess the caries potential of clinical procedures used in orthodontic treatment.

Qualitative and quantitative evaluation of human dental enamel after bracket debonding: a noncontact three-dimensional optical profilometry analysis

ObjectivesThe aim of this study was to undertake a qualitative and quantitative evaluation of changes on enamel surfaces after debonding of brackets followed by finishing procedures, using a high-resolution three-dimensional optical profiler and to investigate the accuracy of the technique.Materials and methodsThe labial surfaces of 36 extracted upper central incisors were examined. Before bonding, the enamel surfaces were subjected to profilometry, recording four amplitude parameters. Brackets were then bonded using two types of light-cured orthodontic adhesive: composite resin and resin-modified glass ionomer cement. Finishing was performed by three different methods: pumice on a rubber cup, fine and ultrafine aluminum oxide discs, and microfine diamond cups followed by silicon carbide brushes. The samples were subsequently re-analyzed by profilometry.ResultsWilcoxon signed-rank test, Kruskal–Wallis test (p < 0.05) and a posteriori Mann–Whitney U test with Bonferroni correction (p < 0.0167) revealed a significant reduction of enamel roughness when diamond cups followed by silicon carbide brushes were used to finish surfaces that had remnants of resin-modified glass ionomer adhesive and when pumice was used to finish surfaces that had traces of composite resin. Enamel loss was minimal.ConclusionsThe 3D optical profilometry technique was able to provide accurate qualitative and quantitative assessment of changes on the enamel surface after debonding.Clinical relevanceMorphological changes in the topography of dental surfaces, especially if related to enamel loss and roughness, are of considerable clinical importance. The quantitative evaluation method used herein enables a more comprehensive understanding of the effects of orthodontic bonding on teeth.

Craniofacial analysis of the Tweed Foundation in Angle Class II, division 1 malocclusion

This study has defined the cephalometric values of the Craniofacial Analysis of the Tweed Foundation for a sample of Brazilian subjects. The sample consisted of 211 cephalometric radiographs from subjects aged 12-15, which were divided into two groups: Class II group, with 168 lateral teleradiographs (cephalograms) of white Brazilian subjects, with Angle Class II, division 1 malocclusion, of both genders (82 males and 86 females); and the Control Group, with 43 lateral teleradiographs (cephalograms) of subjects whose occlusion was clinically excellent, and also of both genders (21 males and 22 females). The teleradiographs were selected from the files of the Department of Orthodontics, School of Dentistry of Piracicaba, State University of Campinas, previously to the orthodontic treatment. The results demonstrated no sexual dimorphism for each group, as attested by the Students t-test. The exploratory analysis (+/- 0.5 standard deviation) enabled the tolerance limits to be determined and a Craniofacial Analysis Table to be constructed using the respective cephalometric intervals. In addition, the difference between the two groups was not statistically significant according to the maxilla position. The maxilla was in a good position in relation to the cranial base. On the other hand, the mandible was retruded in relation to the cranial base in the Class II cases. The skeletal pattern was not defined because only the Facial Height Index (FHI) showed a vertical pattern in Class II subjects, while the Y Axis, SN.PlO, SN.GoMe and FMA values did not show any statistically significant difference between the groups. The Class II division 1 subjects showed lower incisors more labially tipped and a convex facial profile.

Analysis of the coefficient of variation in shear and tensile bond strength tests

The coefficient of variation is a dispersion measurement that does not depend on the unit scales, thus allowing the comparison of experimental results involving different variables. Its calculation is crucial for the adhesive experiments performed in laboratories because both precision and reliability can be verified. The aim of this study was to evaluate and to suggest a classification of the coefficient variation (CV) for in vitro experiments on shear and tensile strengths. The experiments were performed in laboratory by fifty international and national studies on adhesion materials. Statistical data allowing the estimation of the coefficient of variation was gathered from each scientific article since none of them had such a measurement previously calculated. Excel worksheet was used for organizing the data while the sample normality was tested by using Shapiro Wilk tests (alpha = 0.05) and the Statistical Analysis System software (SAS). A mean value of 6.11 (SD = 1.83) for the coefficient of variation was found by the data analysis and the data had a normal distribution (p>0.05). A range classification was proposed for the coefficient of variation from such data, that is, it should be considered low for a value lesser than 2.44; intermediate for a value between 2.44 and 7.94, high for a value between 7.94 and 9.78, and finally, very high for a value greater than 9.78. Such classification can be used as a guide for experiments on adhesion materials, thus making the planning easier as well as revealing precision and validity concerning the data.