Fernando César Torres

Effect of a low-level laser on bone regeneration after rapid maxillary expansion

INTRODUCTION In this study, we evaluated the effects of a low-level laser on bone regeneration in rapid maxillary expansion procedures. METHODS Twenty-seven children, aged 8 to 12 years, took part in the experiment, with a mean age of 10.2 years, divided into 2 groups: the laser group (n = 14), in which rapid maxillary expansion was performed in conjunction with laser use, and the no-laser group (n = 13), with rapid maxillary expansion only. The activation protocol of the expansion screw was 1 full turn on the first day and a half turn daily until achieving overcorrection. The laser type used was a laser diode (TWIN Laser; MMOptics, São Carlos, Brazil), according to the following protocol: 780 nm wavelength, 40 mW power, and 10 J/cm(2) density at 10 points located around the midpalatal suture. The application stages were 1 (days 1-5 of activation), 2 (at screw locking, on 3 consecutive days), 3, 4, and 5 (7, 14, and 21 days after stage 2). Occlusal radiographs of the maxilla were taken with the aid of an aluminum scale ruler as a densitometry reference at different times: T1 (initial), T2 (day of locking), T3 (3-5 days after T2), T4 (30 days after T3), and T5 (60 days after T4). The radiographs were digitized and submitted to imaging software (Image Tool; UTHSCSA, San Antonio, Tex) to measure the optic density of the previously selected areas. To perform the statistical test, analysis of covariance was used, with the time for the evaluated stage as the covariable. In all tests, a significance level of 5% (P <0.05) was adopted. RESULTS From the evaluation of bone density, the results showed that the laser improved the opening of the midpalatal suture and accelerated the bone regeneration process. CONCLUSIONS The low-level laser, associated with rapid maxillary expansion, provided efficient opening of the midpalatal suture and influenced the bone regeneration process of the suture, accelerating healing.

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.

Dentoalveolar comparative study between removable and fixed cribs, associated to chincup, in anterior open bite treatment.

Objective The aim of this prospective study was to compare the dentoalveolar effects produced by two types of palatal crib, removable (Rpc+C) and fixed (Fpc+C), combined with chincup in growing patients with anterior open bite. Material and Methods Each group comprised 30 patients, in the mixed dentition phase, with similar cephalometric characteristics and skeletal ages. Group 1 (Rpc+C) presented initial mean age of 8.3 years and mean anterior open bite of 4.0 mm. Group 2 (Fpc+C) presented initial mean age of 8.54 years and mean anterior open bite of 4.3 mm. The evaluation period comprised 12 months between initial (T1) and second lateral radiograph (T2). The T2-T1 changes were compared cephalometrically in the 2 groups using the non-paired t-test. Results Vertical changes in the posterior dentoalveolar region were similar between the groups (about 1 mm) and no significant differences were found in molar mesialization. The Fpc+C group had in average 1.6 mm more improvement of the overbite as a result of greater maxillary incisor extrusion (1.3 mm). Patients in this group also presented less lingual tipping of maxillary incisors and more mandibular incisors uprighting. Conclusions The Fpc+C combination was more efficient in the correction of the negative overbite mainly due to greater extrusion of the maxillary incisors. However, the Rpc+C appliance promoted better upper and lower incisor inclination, resulting in a more adequate overjet.

Class I malocclusion treatment: Influence of a missing mandibular incisor on anterior guidance

This case report describes the orthodontic treatment of a patient with a deep-overbite Angle Class I malocclusion, agenesis of a mandibular central incisor, and 2 supernumerary teeth, which caused impaction of the mandibular first premolars. The 15-year-old patient also had a convex profile, maxillary dentoalveolar protrusion, and deficiency of space for the correct alignment of teeth. Therefore, treatment consisted of fixed appliance therapy, cervical headgear, extraction of the supernumeraries and the mandibular and maxillary first premolars, and mesiodistal reduction of the maxillary incisors to solve the arch perimeter discrepancy as much as possible with interproximal stripping. This method of treatment significantly improved the patients facial and dental esthetics and provided a good functional occlusion, despite the absence of a mandibular incisor, which generally impairs achieving adequate incisal guidance.

Correlation between maxillary central incisor crown morphology and mandibular dental arch form in normal occlusion subjects

The aim of this study was to evaluate the correlation between the morphology of the mandibular dental arch and the maxillary central incisor crown. Cast models from 51 Caucasian individuals, older than 15 years, with optimal occlusion, no previous orthodontic treatment, featuring 4 of the 6 keys to normal occlusion by Andrews (the first being mandatory) were observed. The models were digitalized using a 3D scanner, and images of the maxillary central incisor and mandibular dental arch were obtained. These were printed and placed in an album below pre-set models of arches and dental crowns, and distributed to 12 dental surgeons, who were asked to choose which shape was most in accordance with the models and crown presented. The Kappa test was performed to evaluate the concordance among evaluators while the chi-square test was used to verify the association between the dental arch and central incisor morphology, at a 5% significance level. The Kappa test showed moderate agreement among evaluators for both variables of this study, and the chi-square test showed no significant association between tooth shape and mandibular dental arch morphology. It may be concluded that the use of arch morphology as a diagnostic method to determine the shape of the maxillary central incisor is not appropriate. Further research is necessary to assess tooth shape using a stricter scientific basis.

Avaliação microbiológica da contaminação residual em diferentes tipos de alicates ortodônticos após desinfecção com álcool 70

AIM: The aim of this study was to verify, by means of microbiological analysis, the contamination in different kinds of orthodontic pliers (Distal End Cutter, Bird Beak, Band Remover and Weingart), after washing with water and detergent and followed by disinfection with 70% alcohol for 1 minute. METHODS: All the pliers were, initially, sterilized in autoclave for 20 minutes, at 121oC and 1atm of pressure. After the orthodontic appointment, the pliers were adequately transported to Microbiology Laboratory and the evaluations of variety and quantity of bacteria were made. Afterward, the same pliers were washed with water and detergent, and rubbed with gauze with 70% alcohol (p/p) for 1 minute. New bacteriological tests were done and compared to a control group of non utilized pliers. RESULTS: Results showed a great quantity and variety of residual bacteria after the disinfection with alcohol. CONCLUSIONS: Even pliers not inserted in patient mouth, but only handed by clinician, should be sterilized, once merely disinfection is not an adequate method for infection control.

Evaluation of the stability of open bite treatment using a removable appliance with palatal crib combined with high-pull chincup

OBJECTIVE: The aim of this prospective study was to cephalometrically analyze the stability of dentoalveolar and skeletal changes produced by a removable appliance with palatal crib associated to high-pull chincup in individuals with anterior open bite treated for 12 months, and compare them to individuals with similar malocclusion and age, not submitted to orthodontic treatment, also followed for the same period. METHODS: Nineteen children with a mean age of 9.78 years old treated for 12 months with a removable appliance with palatal crib associated with chincup therapy were evaluated after 15 months (post-treatment period) and compared with a control group of 19 subjects with mean age of 9.10 years with the same malocclusion that was followed-up for the same period. Seventy-six lateral cephalograms were evaluated at T1 (after correction) and T2 (follow-up) and cephalometric variables were analyzed by statistical tests. RESULTS: The results did not show significant skeletal, soft tissue or maxillary dentoalveolar changes. Overall, treatment effects on the experimental group were maintained at T2 evaluation with an increase of 0.56 mm in overbite. Overjet and maxillary incisors/molars position (vertical and sagittal) remained essentially unchanged during the study period. Only mandibular incisors showed significant changes (labial inclination and protrusion) compared to control group. CONCLUSIONS: Thus, it can be concluded that the early open bite treatment with a removable appliance and palatal crib associated with high-pull chincup therapy provided stability of 95%.

Ethical and legal considerations on professional liability of the orthodontist

INTRODUCTION: After the enactment of Law 8078, of September 11, 1990, the Consumers Defense Code implied important alterations in Brazils legal scenario, providing a greater balance in the relationship between consumers and service providers. From this law, dental surgeons came to establish a consumer relationship with their clients. OBJECTIVE: Due to the ethical and legal issues against the dental professionals, this work makes general considerations about the nature of the dentist´s obligation in services, specifically in Orthodontics. CONCLUSION: The responsibility of the professional shall be restricted to predictable risks and undertaken obligations. When the professional warns the client in a correct, clear and express manner, it will lower the chances of being later charged.

Evaluation of the dental arch asymmetry in natural normal occlusion and Class II malocclusion individuals

Objective: To verify the presence and degree of asymmetry of dental arches in Brazilian individuals with natural normal occlusion and Class II, Divisions 1 and 2 malocclusions. Methods: The study evaluated the symmetry of the maxillary and mandibular dental arches of 180 pairs of dental casts, divided into: Group I = 60 pairs of natural normal occlusion individuals; Group II = 60 pairs of Class II, Division 1 malocclusion individuals; and Group III = 60 pairs of Class II, Division 2 malocclusion individuals. A device was used to measure dental midline deviation and the canine tip in the dental arches (in degrees). It was also verified the distance of the upper canines from the palatal suture, intercanine distance, and anteroposterior upper and lower first molar position. Results: Dental arches of individuals from all groups presented asymmetry, regardless of the presence of malocclusion. Group I showed a lower asymmetry degree in relation to Groups II and III. The asymmetry in Groups II and III was similar. Conclusion: The dental arches of individuals with natural normal occlusion and with Class II, Division 1 and Division 2 malocclusions showed asymmetry. The asymmetry degree was higher in the mandibular dental arches than in the maxillary dental arches in all 3 evaluated groups.

Incidental findings in patients evaluated with cone beam computed tomography for orthodontic treatment

ABSTRACT ObjectiveThe aim of this retrospective study was to determine and quantify incidental findings in CBCT scans taken exclusively for orthodontic purposes. MethodsA total of 202 scans were evaluated by two examiners and classified into five different groups. ResultsA total of 227 incidental findings were found in a sample of patients aged 5-58 years old. The highest number of findings was of dental origin (n = 157), followed by airway (N = 46), skull (N = 16) and ATM (n = 8). Scans with no incidental finding accounted for 20% of the examinations. Subjects having lower mean age were found in the group of airway findings. The prevalence of incidental findings in the current study was consistent with the literature, thus corroborating their high frequency. Orthodontists who make use of CBCT are responsible for assessment of all data. ConclusionThe precise evaluation of incidental findings may help in the early diagnosis, treatment and patient monitoring. Further studies should be conducted to assess the influence of these findings on the orthodontic treatment.Indexing terms: Diagnostic imaging. Incidental findings. Orthodontics.