Henrique Damian Rosário

Time of guard of orthodontic records versus legal time for their prescription.

INTRODUCTION After promulgation and wider dissemination of the Code of Consumer Protection (CCP), there was an increase in the number of legal conflicts between patients and dentists, leading these health professionals to increasingly guard themselves from possible lawsuits. As such, it becomes critical the preparation of an adequate and complete clinical record, even though the keeping time remains uncertain. OBJECTIVE To review the literature and discuss the keeping time of orthodontic records versus the legal time for their prescription, as well as to propose a model of a Term upon Completion of Dental Treatment. CONCLUSIONS It is advised to return part of the clinical records to their rightful owners by means of an itemized receipt. The Term upon Completion reflects the patients awareness and could be considered by the CCP as the initial term of the prescription time, because it implicates that the patient recognizes the quality of service provided and satisfactory results achieved.

Determination of vertical characteristics with different cephalometric measurements

Objective: To analyze a possible correlation between different measures in the definition of vertical facial types. Materials and Methods: This is an analytical observational study about 95 lateral teleradiographs of Caucasian individuals with normal occlusion, of which 54 were male (56.84%) and 41 female (43.16%), aged between 15 years and 2 months old and 21 years and 4 months old. Facial types were divided into dolichofacial, mesofacial, and brachyfacial, according to the standards established by different authors. A relationship between these measurements was verified using total agreement analysis and the Kappa method, with the interpretation suggested by Landis and Koch. Results: Kappa was considered fair for Jarabak X VERT (0.22 and 60%) and slight for Jarabak X SN.GoGn (0.06 and 36.8%). Conclusions: Cephalometric studies often present different interpretations on the description of vertical facial types. In this study, the lowest agreement was between Jarabak and SN.GoGn. Such difference in interpretation may lead to distinct therapeutic approaches and thus different results.

Bolton ratio in subjects with normal occlusion and malocclusion

Aim: To verify the presence of Bolton anterior and total discrepancy in Brazilian individuals with natural normal occlusion and Angle’s Class I and Class II, division 1 malocclusions. Methods: The sample was divided in three groups (n=35 each): natural normal occlusion; Class I malocclusion; Class II, division 1 malocclusion. Of the 105 Caucasian Brazilian individuals, 24 were boys and 81 were girls aged from 13 to 17 years and 4 months. The mesiodistal width of the maxillary and mandibular teeth, from the left first molar to the right first molar, was measured on each pre-treatment dental plaster cast using a digital caliper accurate to 0.01 mm resolution. Values were tabulated and the Bolton ratio was applied. The Kolmogorov-Smirnov test was used to verify if data were normally distributed (p>0.2). For comparison between the values obtained and those from the Bolton standard, Student’s t test was used and one-way ANOVA was used for comparisons among the 3 groups, with a significance level of 5% (p<0.05). Results: For groups 1, 2 and 3, respectively, the total ratio found was 90.36% (SD 1.70), 91.17% (SD±2.58) and 90.76% (SD±2.45); and the anterior ratio was 77.73% (SD 2.39), 78.01% (SD 2.66) and 77.30% (SD 2.65). Conclusions: There was no significant difference among the groups regarding the values indicated in the Bolton ratio.

Reply to the comment on: "Efficiency of bimaxillary advancement surgery in increasing the volume of the upper airways: a systematic review of observational studies and meta-analysis".

Dept Orthodont, Fac Integradas Norte Minas FUNORTE, Dept Orthodont, Florianopolis, SC, Brazil

Soft-tissue cone-beam computed tomography (ST-CBCT) technique for the analysis of skeletal, dental and periodontal effects of orthopedic rapid maxillary expansion

Background Orthopedic rapid maxillary expansion (RME) is a common treatment of choice for managing transverse deficiency of the maxilla. This approach may have desired and undesired skeletal, dental and periodontal effects that may be assessed clinically or through imaging techniques. This study aims to investigate the dental, skeletal and periodontal effects of orthopedic RME using the soft-tissue cone-beam computed tomography (CBCT) technique. Material and Methods The sample consisted of 10 patients (5males and 5 females) aged between 10 and 14 years (mean age: 12.5 years) treated with Hyrax orthopedic device. CBCT scans set for the registration of soft tissue (ST-CBCT) were taken from each patient before (T1) and 120 days after (T2) RME. Skeletal (n=10), dental (n=1) and periodontal (n=4) parameters measured in ST-CBCT were compared between T1 and T2 using t-test within a significance level of 5%. Results The skeletal parameters with statistically significant increase (p<0.05) in T2 were the width of the buccal alveolar bone crest, the external width of the dental arch at the level of buccal cusps, and the width of the dental arch at the level of most prominent dental surface contour. Representing the dental parameter, the inclination of the anchor teeth was statistically significant for premolars (p<0.05). The only statistically significant outcome in periodontal parameters was the decrease in buccal bone plate thickness of first molars (p<0.05). Conclusions Dentists must be aware of the ST-CBCT technique for the analysis of hard and soft tissue after orthodontic and orthopedic treatments. This technique revealed that the RME reached optimal skeletal and dental effects with minimal periodontal side effects. Key words:Cone-beam computed tomography, imaging, orthodontics, orthopedics.

Can 10% hydrofluoric acid be used for reconditioning of orthodontic brackets?

Context: Bracket debonding is a common problem during orthodontic treatment. This type of failure is associated to masticatory forces, poor adhesion, and the need for repositioning the piece. Aims: The objective of this work was to compare the shear bond strength of debonded brackets that were reconditioned using different protocols (alumina blasting versus hydrofluoric etching). Settings and Design: This was an in vitro experimental study with 45 stainless steel orthodontic brackets. Subjects and Methods: They were randomly divided into three groups: (1) New brackets (n = 15), (2) brackets reconditioned using 10% hydrofluoric acid for 60 s (n = 15), and (3) brackets reconditioned by aluminum oxide blasting until complete removal of the remaining resin (n = 15). In Groups 2 and 3, the insertion of composite resin proceeded in two stages to simulate a type of bracket failure in which the bonding resin was left at the bracket base. For the shear test, the assembly composed by the metallic support, and specimen was taken to the Instron universal testing machine in which the specimens were loaded using a semicircle-shaped active tip in the region of the bonding interface parallel to the surface of the bracket at a speed of 0.5 mm/min. Statistical Analysis Used: The data were subjected to D′Agostino′s normality test to have their distribution checked. Analysis of variance and Tukey′s test (P < 0.01) were used to compare the findings between groups. Results: The results indicated that Group 1 (new brackets) showed higher bond strength than that obtained for the group treated with hydrofluoric acid (Group 2, P < 0.01). The bond strength value obtained for the group treated with alumina blasting (Group 3) was statistically similar to those obtained for Groups 1 and 2. Conclusions: The aluminum oxide blasting technique was effective for the reconditioning of orthodontic brackets. Nevertheless, the reconditioning technique using 10% fluoridric acid for 60 s was not efficient for clinical use.

Evaluation of changes in clinical crown length of lower anterior teeth after treatment with Frankel-2's appliance.

PURPOSE The aim of this study was to test the null hypothesis that there is no change in the lower anterior teeths crown size when measured just after the treatment with Frankel-2s orthopedic appliance and in a long-term posttreatment follow-up. MATERIALS AND METHODS The sample was composed of 34 plaster models belonging to 9 male and 8 female individuals, treated at the College of Health, Methodist University of São Paulo, São Bernardo do Campo, São Paulo, Brazil, with mean age of 12 years and 6 months (standard deviation [SD] =7 months) at T1 (end of the treatment with Frankel-2s function regulator), and 19 years and 8 months (SD = 7 months) at T2 (7.11 years after the end of the treatment). RESULTS The distance from the incisal edge to the most concave portion of the gingival margin of the lower incisors and canines was measured using a digital caliper. Data analysis was carried out by means of Students t-test and paired-t test. Among the lower anterior teeth, the teeth 31, 33, 42 and 43 showed a statistically significant increase in their crown length, whereas the teeth 32 and 41 showed no changes. CONCLUSION It can be concluded that there is a tendency to increase the clinical crown of lower anterior teeth throughout the years after the mandibular advancement treatment by using functional devices, rejecting the null hypotheisis.