Flavia Artese

Avaliação do torque para inserção, remoção e fratura de diferentes mini-implantes ortodônticos

AIM: The purpose of this study was to evaluate mini-implants with different dimensions for the following factors: (a) insertion torque, (b) removal torque, (c) fracture torque, (d) shear tension, (e) normal tension and (f) type of fracture. METHODS: Twenty self-drilling mini-implants were used, 10 from SIN and 10 from Neodent, with 1.6mm in diameter and with 8 and 7mm in length, respectively. Out of these 10 mini-implants, 5 did not have a neck and the other 5 had a 2mm neck, and were separated into 4 groups: SIN without neck (SSP), SIN with neck (SCP), Neodent without neck (NSP) and Neodent with neck (NCP). All mini-implants were inserted in bone cortex and removed with a low speed handpiece connected to a digital torquimeter. The mini-implants were also submitted to a fracture test. The insertion, removal and fracture torques, as well as the calculated shear and normal tensions, were compared between all groups by ANOVA. The type of fracture was assessed by a scanning electronic microscope. RESULTS: The NCP group presented a significantly greater insertion torque than all other groups, but all of them fractured during insertion (n = 2) or removal (n = 3). There were no significant differences among groups for removal torque. For group NSP, the fracture torque was significantly smaller than all other groups. All mini-implants suffered ductile fracture. CONCLUSION: Since there were no differences for the mechanical resistance of both brands of mini-implants, varying only in shape, one may conclude that resistance to fracture can be affected by this variable.

Force extension relaxation of medium force orthodontic latex elastics

OBJECTIVE To evaluate the force extension relaxation of different manufacturers and diameters of latex elastics subjected to static tensile testing under dry and wet conditions. MATERIALS AND METHODS Sample sizes of 15 elastics from American Orthodontics (AO) (Sheboygan, Wis), TP (La Porte, Ind), and Morelli Orthodontics (Sorocaba SP, Brazil) were used. Equivalent medium force products were tested--3/16, 1/4, and 5/16 inch lumen size from each manufacturer--making a total of 1080 specimens. An apparatus was designed to simulate oral environments during elastics stretching. Forces were read after 1, 3, 6, 12, and 24 hour periods using the Emic Testing Machine (Emic Co., Sao Paulo, Brazil) with 30 mm/min cross-head speed and load cell of 20 N (Emic Co). Kruskal-Wallis and Dunns tests were used to identify statistical significance. RESULTS Statistical differences between AO and the other brands were noted for all testing times. Significant variation in mechanical properties was observed in latex elastics from Morelli. Relationships among loads at the 0 hour time period were as follows: Morelli>AO>TP for 3/16 elastics (P = .0016), 1/4 elastics (P = .0016), and 5/16 elastics (P = .0087). CONCLUSION Significant differences in force extension relaxation were noted for elastics from these manufacturers. Force relaxation over the 24 hour time period was AO>Morelli>TP for 3/16 elastics, AO>TP>Morelli for 1/4 elastics, and TP>AO>Morelli for 5/16 elastics. The force decay pattern showed a notable drop-off of forces during 0 to 3 hours, a slight increase in force values from 3 to 6 hours, and a progressive force reduction over 6 to 24 hours.

Surgical prediction of skeletal and soft tissue changes in treatment of Class II

INTRODUCTION The purpose of this study was to study the treatment outcomes and the accuracy of digital prediction and the actual postoperative outcome with Dolphin program on subjects presenting Class II malocclusions. METHODS Forty patients underwent surgical mandibular advancement (Group 1) and 40 underwent combined surgery of mandibular advancement and maxillary impaction (Group 2). The available pre surgical (t₁) and a minimum of 12 months post surgical (t₂) cephalometric radiographs were digitized. Predictive cephalograms (t₃) for both groups were traced. RESULTS At all times evaluated, Group 1 displayed a shorter mandibular length and Group 2 had a longer lower face. In both groups the surgical interventions (t₂) were greater than initially predicted. There was no significant difference between groups with regards to overjet, overbite and soft tissue measurements. CONCLUSIONS In both groups surgeries were more extensive than planned. Facial convexity and the distance of the lips to cranial base presented similar values between t₂ (post surgical) and t₃ (predicted).

Comparação entre a radiografia de cavum e a cefalométrica de perfil na avaliação da nasofaringe e das adenoides por otorrinolaringologistas

INTRODUCAO: tanto a radiografia cefalometrica de perfil quanto a de cavum permitem a avaliacao do espaco aereo nasofaringeo (EAN). Nao e rara a solicitacao dos otorrinolaringologistas de radiografia de cavum, mesmo o paciente possuindo uma cefalometrica. OBJETIVOS: objetivou-se (a) conhecer quais exames os otorrinolaringologistas solicitam para avaliar o EAN; (b) verificar o conhecimento da cefalometrica por otorrinolaringologistas; (c) comparar a avaliacao de otorrinolaringologistas nas duas tecnicas radiograficas para a medicao e a visualizacao do EAN e da adenoide; (d) correlacionar os resultados do metodo de inspecao visual com os da medicao de Schulhof. METODOS: foram obtidas, no mesmo dia, radiografias cefalometricas e de cavum de 15 pacientes respiradores bucais. Essas foram cobertas com papel cartao, deixando visivel apenas o EAN e adenoides e foram avaliadas por 12 otorrinolaringologistas. Estes respondiam sobre sua familiaridade com a cefalometrica, quais exames solicitam para visualizar EAN e adenoides e se utilizam algum metodo de medicao do grau de obstrucao. Avaliavam qual das radiografias apresentava a melhor visualizacao da adenoide e do EAN, e classificavam o tamanho dos mesmos em pequeno, medio ou grande, atraves de metodo visual. RESULTADOS: os resultados demonstraram que todos os otorrinolaringologistas costumam solicitar a radiografia de cavum. Apenas um solicita a cefalometrica, dois estao familiarizados com essa tecnica e um utiliza algum metodo de medicao do EAN. A cefalometrica foi preferida por 49,4% dos otorrinolaringologistas, a de cavum por 22,8%, enquanto 27,8% nao observaram diferenca entre ambas. Foi encontrada baixa correlacao entre o metodo de medicao visual e o de Schulhof.

Influence of surface treatment on shear bond strength of orthodontic brackets

INTRODUCTION The shear bond strength of orthodontic brackets bonded to micro-hybrid and micro-particulate resins under different surface treatment methods was assessed. METHODS Two hundred and eighty test samples were divided into 28 groups (n = 10), where 140 specimens were filled with Durafill micro-particulate resin and 140 with Charisma composite. In 140 samples, a coupling agent (silane) was applied. The surface treatment methods were: Phosphoric and hydrofluoric acid etching, sodium bicarbonate and aluminum oxide blasting, stone and burs. A Universal Instron Machine was used to apply an occlusal shear force directly to the resin composite bracket surface at a speed of 0.5 mm/min. The means were compared using analysis of variance and multivariate regression to assess the interaction between composites and surface treatment methods. RESULTS Means and standard deviations for the groups were: Sodium bicarbonate jet 11.27 ± 2.78; burs 9.26 ± 3.01; stone 7.95 ± 3.67; aluminum oxide blasting 7.04 ± 3.21; phosphoric acid 5.82 ± 1.90; hydrofluoric acid 4.54 ± 2.87, and without treatment 2.75 ± 1.49. An increase of 1.94 MPa in shear bond strength was seen in Charisma groups. Silane agent application reduced the Charisma shear bond strength by 0.68 Mpa, but increased Durafill means for bicarbonate blasting (0.83), burs (0.98) and stone drilling (0.46). CONCLUSIONS The sodium bicarbonate blasting, burs and stone drilling methods produced adequate shear bond strength and may be suitable for clinical use. The Charisma micro hybrid resin composite showed higher shear bond means than Durafill micro particle composite.

Conceitos atuais sobre a intrusão traumática de dentes permanentes: epidemiologia, efeitos de fatores antes e durante o trauma e variáveis de tratamento

, baseados em uma analise longitudinal dos casos de intrusao de dentes perma-nentes atendidos no servico de trauma do Hospital Universitario de Copenhagen, acompanhados de 1955 a 2003, totalizando 216 dentes. Questoes epidemiolo-gicas, fatores antes e durante o trauma e variacoes de tratamento que afetariam a recuperacao de um dente intruido foram abordados. No primeiro artigo os autores apresentam de manei-ra detalhada o protocolo utilizado para obter informa-coes clinicas, documentacao fotografica e radiografica de pacientes que sofreram trauma dentario no servico do Hospital Universitario de Copenhagen. Apos co-lherem estes dados, os pacientes com dentes intruidos eram submetidos a um destes tres metodos de trata-mento: aguardar erupcao espontânea, reposicionamen-to cirurgico ou extrusao ortodontica. Alem disso todos os dentes tratados eram esplintados por 6 a 8 semanas e 500mg de penicilina eram administrados 4 vezes ao dia durante 4 dias. Os pacientes eram acompanhados em intervalos regulares de 3, 4, 6 e 8 semanas, 6 meses e anualmente ate 5 anos apos o trauma. Os resultados deste estudo epidemiologico mostram que a intrusao constitui 1,9% dos traumas em dentes permanentes, sendo sua causa principal a queda contra superficies duras. A faixa etaria entre 6 e 12 anos foi a mais acome-tida, ocorrendo mais cedo com os meninos do que com as meninas. O padrao de trauma poderia incluir de 1 a 5 dentes, sendo mais comum 1 ou 2 dentes intruidos. A localizacao mais frequente e na regiao anterior da maxila, sendo muito rara nos dentes inferiores. A exten-sao de intrusao pode variar de 1 a 20mm, sendo mais comum ate 8 mm. O parâmetro clinico mais usual foi o som oco a percussao (79%) e o parâmetro radiografico mais confiavel para avaliar a quantidade de intrusao foi a distância da juncao amelo-cementaria de um dente irrompido ao do dente intruido. A obliteracao do liga-mento periodontal foi vista em 51,8% dos casos.O segundo artigo teve como objetivo avaliar os efei-tos de fatores existentes antes e durante o trauma sobre possiveis complicacoes pos-tratamento, isto e, a necrose pulpar (NP), reabsorcao radicular (RR) e perda de in-sercao periodontal (PP). Os fatores considerados foram: genero, idade, estagio de desenvolvimento radicular, localizacao do dente, fraturas dentarias associadas, se-veridade do deslocamento e o numero de dentes envol-vidos. Dos 216 dentes avaliados inicialmente 76 foram retirados do estudo, totalizando 140 dentes. Os resulta-dos apresentaram que 124 dentes sofreram NP, sendo a maior parte em 6 meses pos-trauma. A NP estava sig-nificativamente associada ao grau de desenvolvimento radicular, sendo mais tardia em dentes com rizogenese incompleta. A RR ocorreu em 67 casos e tambem esta-va associada com o grau de desenvolvimento radicular. A maior parte dos casos foi diagnosticada 1 ano apos o trauma, apresentando um plato de cicatrizacao nos 5 anos subsequentes e havendo reinicio da reabsorcao ate 10 anos apos o trauma. A PP ocorreu em 45 casos e novamente estava associada com o grau de desenvol-vimento radicular. A maior parte da perda de insercao ocorreu nos primeiros 4 anos em casos com rizogenese incompleta, enquanto dentes com raizes completamen-te formadas apresentavam perda de insercao continua, durante todo o periodo de observacao. Quando estes dados foram analisados com as variaveis antes e durante o trauma, verificou-se que quanto maior a idade, maior o numero de complicacoes pos-tratamento. A mesma situacao foi verificada com o grau de desenvolvimento radicular. A PP esta mais associada com a intrusao dos incisivos laterais. Nos casos de fraturas coronarias existe associacao com NP. O grau de severidade da intrusao, no caso, mais do que 7mm, aumenta a chance de haver todas as complicacoes consideradas (NP, RR e PP). O numero de dentes intruidos aumenta a chance de PP, principalmente nas regioes proximais entre dois dentes adjacentes traumatizados.O terceiro artigo propos avaliar a influencia de fa-tores de tratamento como demora no atendimento, me-todo de reposicionamento, tipo de esplintes, tempo de esplintagem e o uso de antibioticos, sobre as mesmas complicacoes pos-tratamento (NP, RR e PP). A mes-ma amostra de 140 dentes foi utilizada. Os metodos de esplintagem utilizados foram: rigida (esplintes feitos de prata ou resina acrilica), semi-rigida (com fios orto-donticos) e flexivel (esplintes em resina flexivel). Os metodos de reposicao do dente intruido foram re-erup-cao espontânea, reposicionamento cirurgico ou extru-sao ortodontica. Nos casos que foram atendidos um dia apos o trauma apenas a PP teve pior resultado. Os den-tes que nao foram reposicionados, isto e, onde aguar-dou-se a re-erupcao espontânea, apresentaram melho-

Point of equilibrium

© 2018 Dental Press Journal of Orthodontics Dental Press J Orthod. 2018 Mar-Apr;23(2):7-8 7 Historically, humanity alternates cycles in its relentless search for explanations in the most diverse spheres, such as arts, philosophy or science. This restlessness, which is inherent to our species, seems to be followed by a certain conflict, because of ingrained beliefs or of habits that we wish to become permanent, be it for protective reasons or for comfort, or simply to establish a point of view. When I read for the first time the transcription of the heated debate between Case, Dewey and Cryer in 1911,1-4 the subjectivity of the opinions in favor or against tooth extractions for orthodontic purposes really made an impression. This could be explained by the fragility of science at that time, but the amount of “nevers” and “always” are very clear on each side of the debacle. Along the history of our specialty, this pendulum of changes fortunately continues to swing. Since the invention of cephalometry and its adoption by Tweed as a diagnostic tool, his non-extraction treatments underwent a re-evaluation. Intrigued by his dissatisfaction with his patients’ faces, Tweed developed a new diagnostic procedure that changed orthodontics forever, establishing objective criteria to indicate tooth extractions.5 Even though nowadays we know that extractions do not guarantee the stability promulgated by Tweed, its need for facial changes or for solving dental crowding was adapted to contemporary orthodontics. Such procedure is sufficiently settled and does not create uproar any longer. Nevertheless, this relative consensus was achieved after much dissatisfaction, disagreement and many doubts. Flavia Artese Point of equilibrium

Com a superdivulgação profissional, como se proteger de brigas judiciais?

© 2018 Dental Press Journal of Orthodontics Dental Press J Orthod. 2018 July-Aug;23(4):7-8 7 The last decades have witnessed important and profound changes in communications. We exchanged long waits for desired telephone calls, to instant text messages via apps, where we can even acknowledge if the subject is online or not. The world becomes small, reachable at our fingertips by means of portable devices, and the information becomes horizontal, blurring social differences. This generates knowledge and at the same time the demand for services. It is quite natural that the healthcare sector also uses digital communication to offer its services, following the trend of other areas. For Orthodontics, the most recent data that we know of is a paper published by Lindauer and collaborators that evaluated the preferences of orthodontists and patients in relation to social media. The results demonstrated that, in the United States, 76% of orthodontic offices used social network, of which Facebook was the most common, and 59% had a website.1 Even though the Internet brought many positive aspects to dental practice, fraudulent and unethical advertisement are growing, as for example, false advertising2 and those that disobey the professional principles of ethics and code of conduct. In Brazil, we do not have such data, but due to the most recent negative happenings, the professional overexposure in social media is hitting the headlines of the main newspapers in the country.3 This has to be analyzed, since tools that should be used to help in professional marketing can, in reality, because of bad use, tarnish the professional image. In the Special Article of this issue of the Dental Press Journal of Orthodontics (pages 88 to 93), a group of researchers from the Federal University of Juiz de Fora evaluated the risks that orthodontists have to be involved in litigation with indemnity purposes. They concluded that there is significant lack of knowledge on the part of professionals regarding the specific obligations and Flávia Artese With professional overexposure, how to protect

Vertical growth control during maxillary expansion using a bonded Hyrax appliance

INTRODUCTION: Rapid maxillary expansion (RME) for the treatment of maxillary deficiency and posterior crossbite may induce changes in the vertical dimension. Expanders with occlusal splints have been developed to minimize unwanted vertical effects. OBJECTIVE: This preliminary study used cephalometri radiographs to evaluate the vertical effects of RME using a Hyrax appliance in children with maxillary deficiency. METHOD: Twenty-six patients (11 boys; mean age = 8 years and 5 months) with maxillary deficiency and posterior crossbite were treated using a Hyrax appliance with an acrylic occlusal splint. Radiographs and cephalometric studies were performed before the beginning of the treatment (T1) and after RME active time (T2), at a mean interval of 7 months. Results were compared with normative values. RESULTS AND CONCLUSIONS: At the end of treatment, there were no statistically significant changes, and measurements were similar to the normative values. Data showed that there were no significant effects on vertical growth, which suggests that appliances with occlusal splints may be used to correct transverse deficiencies regardless of the patients growth pattern.

Má oclusão Classe II de Angle tratada sem extrações e com controle de crescimento

Angle Class II malocclusion is characterized by an anteroposterior dental discrepancy which is generally accompanied by skeletal disharmonies. Early orthodontic treatment allows the correction of skeletal discrepancies using growth control (first phase) which favors later correction of tooth positioning (second phase). This case report describes an Angle Class II, division 2, malocclusion treated in two phases and was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) as part of the requirements for BBO certification. It was evaluated as a Category 1 case, i.e., Class II malocclusion treated without extractions, with growth control.