Renata Rodrigues de Almeida-Pedrin

Importance of occlusion aspects in the completion of orthodontic treatment

The purpose of this study was to address the therapeutic goals regarding the static and functional occlusion in the completion of orthodontic treatment. For such purpose, a study population comprising 20 female treated Class II malocclusion subjects with an initial mean age of 11 years underwent a two-phase treatment (orthopedics and orthodontics). The patients were diagnosed in centric relation and were treated according to the six keys for normal occlusion and functional occlusal parameters (centric relation, vertical dimension, lateral and anterior guidances, occlusal contacts and direction of forces applied on the teeth). After removal of fixed mechanics, retainers were installed and maintained for two years. Five years after orthodontic completion, the occlusal stability of the patients was evaluated regarding molar relationship and overjet, measured in dental casts. All subjects maintained the normal molar relationship and correct overjet achieved at the end of treatment, indicating a fair level of occlusal stability. The importance of the criteria of the ideal functional occlusion to ensure a better stability after completion orthodontic treatment will be discussed in detail in this paper. In addition, some clinical situations in which localized adjustments are indicated for occlusal refinement will be described.

Treatment effects of bonded spurs associated with high-pull chincup therapy in the treatment of patients with anterior open bite

INTRODUCTION The aim of this prospective clinical study was to investigate the cephalometric changes produced by bonded spurs associated with high-pull chincup therapy in children with Angle Class I malocclusion and anterior open bite. METHODS Thirty patients with an initial mean age of 8.14 years and a mean anterior open bite of -3.93 mm were treated with bonded spurs associated with chincup therapy for 12 months. An untreated control group of 30 subjects with an initial mean age of 8.36 years and a mean anterior open bite of -3.93 mm and the same malocclusion was followed for 12 months for comparison. Student t tests were used for intergroup comparisons. RESULTS The treated group demonstrated a significantly greater decrease of the gonial angle, and increase in overbite, palatal tipping of the maxillary incisors, and vertical dentoalveolar development of the maxillary and mandibular incisors compared with the control group. CONCLUSIONS The association of bonded spurs with high-pull chincup therapy was efficient for the correction of the open bite in 86.7% of the patients, with a 5.23-mm (SD, ±1.69) overbite increase.

Prevalência de má oclusão em crianças de 7 a 12 anos de idade

OBJECTIVE: This study determined the prevalence of malocclusion in a group of 3,466 children aged 7 to 12 years enrolled in public school in the cities of Lins and Promissao, in the state of Sao Paulo, Brazil. METHODS: It was analyzed the sagittal relationships between dental arches, the transverse relationship between arches, and the vertical and horizontal relations of incisors. The prevalence of diastemas, crowding and tooth losses were evaluated. RESULTS: Among the types of malocclusion, 55.25% of the children had a Class I molar relationship; 38%, Class II; and 6.75%, Class III. The analysis of incisor relationships revealed 17.65% of open bite, followed by 13.28% of deep bite and 5.05% of anterior crossbite; 13.3% of the children had a posterior crossbite. The analysis of relationships between arches showed that 31.88% of the children had diastemas; 31.59%, crowding; and 4.65, tooth losses.

A multidisciplinary treatment of congenitally missing maxillary lateral incisors: a 14-year follow-up case report

Absence of the maxillary lateral incisor creates an aesthetic problem which can be managed in various ways. The condition requires careful treatment planning and consideration of the options and outcomes following either space closure or prosthetic replacement. Recent developments in restorative dentistry have warranted a re-evaluation of the approach to this clinical situation. Factors relating both to the patient and the teeth, including the presentation of malocclusion and the effect on the occlusion must be considered. The objective of this study was to describe the etiology, prevalence and alternative treatment modalities for dental agenesis and to present a clinical case of agenesis of the maxillary lateral incisors treated by the closure of excessive spaces and canine re-anatomization. A clinical case is presented to illustrate the interdisciplinary approach between orthodontics and restorative dentistry for improved esthetic results. In this report, the treatment of a girl with a Class II malocclusion of molars and canines with missing maxillary lateral incisors and convex facial profile is shown. Treatment was successfully achieved and included the space closure of the areas corresponding to the missing upper lateral incisors, through movement of the canines and the posterior teeth to mesial by fixed appliances as well as the canines transformation in the maxillary lateral incisors. This is a 14-year follow-up case report involving orthodontics and restorative dentistry in which pretreatment, post-treatment, and long-term follow-up records for the patient are presented.

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.

Assessment of facial profile changes in patients treated with maxillary premolar extractions

OBJETIVO: avaliar as alteracoes do perfil facial decorrentes do tratamento ortodontico com extracoes de dois primeiros pre-molares superiores, sob a optica de ortodontistas, cirurgioes-dentistas e leigos. METODOS: foram tracados os perfis faciais das telerradiografias pre- e pos-tratamento de 70 pacientes com ma oclusao de Classe II, divisao 1, e foi montado um album com as silhuetas dos 70 pacientes, de forma aleatoria, sendo dois perfis em cada folha do mesmo paciente. A seguir, 30 ortodontistas, 30 cirurgioes-dentistas e 30 leigos escolheram o perfil facial mais estetico (A ou B), e a quantidade de alteracao que percebiam entre os dois perfis pre- e pos-tratamento, de acordo com a escala visual analogica (EVA). RESULTADOS: os resultados revelaram que 83 examinadores preferiram o perfil pos-tratamento, sendo que somente tres cirurgioes-dentistas e quatro leigos escolheram com maior frequencia os perfis pre-tratamento. Assim, os ortodontistas escolheram mais frequentemente os perfis pos-tratamento, seguidos pelos cirurgioes-dentistas, sem diferenca estatisticamente significativa entre cirurgioes-dentistas e leigos. Houve diferenca estatisticamente significativa intragrupos na preferencia do perfil pre- e pos-tratamento. Alem disso, os tres grupos de avaliadores indicaram que os perfis pre- e pos-tratamento nao diferiram substancialmente. CONCLUSOES: o tratamento da ma oclusao de Classe II, divisao 1, com extracao de dois primeiros pre-molares produziu um efeito positivo na estetica do perfil facial.

Efeitos do AEB conjugado e do Bionator no tratamento da Classe II, 1ª divisão

Este estudo cefalometrico objetivou avaliar as alteracoes dentarias e esqueleticas, em jovens com ma oclusao de Classe II, 1a divisao, tratados com o aparelho extrabucal conjugado (splint maxilar) e com o Bionator. Estes dois grupos experimentais foram comparados a um grupo de jovens portadores da mesma ma oclusao que nao receberam tratamento, pareados pelo genero, idade, tempo de observacao e grandezas cefalometricas iniciais. A amostra constou de 180 telerradiografias em norma lateral de 90 jovens, divididos em tres grupos de 30, sendo 15 do genero masculino e 15 do feminino. Os jovens do grupo 1 foram mantidos como controle e apresentaram uma idade inicial media de 10,02 anos e foram observados pelo periodo medio de 1,49 anos. O grupo 2 foi submetido ao tratamento utilizando o aparelho extrabucal conjugado (splint maxilar), com idade inicial media de 10,02 anos e tempo de observacao de 1,78 anos. O grupo 3 foi tratado com o Bionator por um tempo medio de 1,52 anos e os jovens apresentavam idade inicial media de 10,35 anos. A analise dos resultados mostrou que o tratamento da ma oclusao de Classe II, 1a divisao com o AEB conjugado e com o Bionator resultou de efeitos especificos e inerentes a cada aparelho. Os resultados patentearam que o deslocamento anterior da maxila foi restringido significantemente pelo tratamento com o AEB conjugado. O Bionator promoveu um aumento significante na protrusao mandibular, enquanto que o AEB conjugado mostrou efeitos esqueleticos menos evidentes. No entanto, ambos aparelhos estudados produziram um aumento nos comprimentos efetivo e do corpo da mandibula, com valores maiores para o grupo 2. A relacao maxilo-mandibular melhorou significantemente nos grupos tratados em comparacao ao grupo controle. A analise do padrao de crescimento craniofacial e das alturas faciais nao revelou alteracao significante entre os grupos. Em relacao as alteracoes dentoalveolares ambos aparelhos provocaram inclinacao para lingual e retrusao dos incisivos superiores, porem os efeitos do AEB conjugado foram significantemente mais intensos. Os incisivos inferiores foram afetados de maneira distinta pelos aparelhos. No grupo tratado com o AEB conjugado, os incisivos lingualizaram e retruiram enquanto que o grupo tratado com o Bionator apresentou inclinacao para vestibular e protrusao destes dentes. Os molares inferiores apresentaram um maior desenvolvimento vertical e horizontal nos grupos 2 e 3. Os primeiros molares superiores distalizaram no grupo tratado com o AEB conjugado, enquanto nos grupos 3 (Bionator) e controle houve mesializacao. Deste modo, verificou-se que ambos os protocolos de tratamento propiciaram alteracoes esqueleticas, dentarias e tegumentares, distintas e clinicamente relevantes para a correcao da ma oclusao de Classe II, 1a divisao.

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.

Diastema interincisivos centrais superiores: quando e como intervir?

Contemporaneamente, os diastemas interincisivos centrais superiores sao vistos como um fator antiestetico sendo altamente prejudicial do ponto de vista social. O diagnostico diferencial dessa anomalia da oclusao deve ser realizado o mais cedo possivel, nao so para orientar o paciente e seus pais bem como para encetar o tratamento procurando devolver ao paciente uma estetica agradavel e o bem estar social. Na realidade o diastema mediano constitui um aspecto de normalidade durante a infância e com o desenvolvimento da oclusao ha um fechamento fisiologico significativo. A sua persistencia depende da etiologia que e multifatorial e geralmente esta relacionada a: discrepância dente-osso positiva, microdontia, agenesias dos incisivos laterais superiores, habitos principalmente de succao, dentes supranumerarios irrompidos ou ainda intra-osseo, hereditariedade, freio labial hipertrofico e outros. O objetivo principal desse trabalho e o de nortear o leitor com relacao a epoca (quando) e como intervir para o cerramento desse espaco. Resumo

Evaluation of facial attractiveness in black people according to the subjective facial analysis criteria

ABSTRACT Objective: The objective of this study was to evaluate the facial attractiveness in 30 black individuals, according to the Subjective Facial Analysis criteria. Methods: Frontal and profile view photographs of 30 black individuals were evaluated for facial attractiveness and classified as esthetically unpleasant, acceptable, or pleasant by 50 evaluators: the 30 individuals from the sample, 10 orthodontists, and 10 laymen. Besides assessing the facial attractiveness, the evaluators had to identify the structures responsible for the classification as unpleasant and pleasant. Intraexaminer agreement was assessed by using Spearmans correlation, correlation within each category using Kendall concordance coefficient, and correlation between the 3 categories using chi-square test and proportions. Results: Most of the frontal (53. 5%) and profile view (54. 9%) photographs were classified as esthetically acceptable. The structures most identified as esthetically unpleasant were the mouth, lips, and face, in the frontal view; and nose and chin in the profile view. The structures most identified as esthetically pleasant were harmony, face, and mouth, in the frontal view; and harmony and nose in the profile view. The ratings by the examiners in the sample and laymen groups showed statistically significant correlation in both views. The orthodontists agreed with the laymen on the evaluation of the frontal view and disagreed on profile view, especially regarding whether the images were esthetically unpleasant or acceptable. Conclusions: Based on these results, the evaluation of facial attractiveness according to the Subjective Facial Analysis criteria proved to be applicable and to have a subjective influence; therefore, it is suggested that the patients opinion regarding the facial esthetics should be considered in orthodontic treatmentplanning.