Class II subdivision treatment and stability with asymmetric Herbst appliance: A case report

Non-surgical treatment of Class II subdivision may involve complex mechanics or asymmetric tooth extraction in its resolution. This report demonstrates the result and the short-term stability of Class II subdivision treated with asymmetrically installed Herbst appliance followed by conventional fixed orthodontic appliance. The approach allowed the correction of the unilateral Class II molar relationship and increased overjet, as well as the deviation of dental midlines, with improvement in lip posture and facial profile. The results remained stable two years after treatment, confirming the treatment success.

Effectiveness and predictability of treatment with clear orthodontic aligners: A scoping review

INTRODUCTION

In an ideal clinical setting, orthodontic therapy with clear aligners (CA) should improve the patients' initial malocclusion and must guarantee equivalence between the results predicted and those obtained clinically to be considered an effective treatment. Therefore, this scoping review aimed to identify the orthodontic literature concerning the effectiveness and predictability of CA treatments.

METHODS

A systematic computerized search was performed in 3 databases: PubMed, Scopus, and Embase. Inclusion criteria selected observational and clinical studies performed in at least 10 adult orthodontic patients, whose results of CA treatment's effectiveness and/or predictability were assessed.

RESULTS

The 3 database computerized searches resulted in 1,553 articles, and 169 full texts were considered potentially relevant. After applying the eligibility criteria, 33 studies were included. Most studies (76%) were designed as cohort studies and have been published in the last 5 years (79%). The majority included only non-extraction treatments (73%), and 79% reported results achieved with the Invisalign® system. The most predictable movement was the buccolingual tipping, while the least predictable movements were rotation, intrusion, and extrusion. Aligner treatment was effective for mild to moderate crowding resolution, and the success of overbite correction still seems to be limited.

CONCLUSIONS

The studies have demonstrated improvement of initial malocclusion through CA treatments. Still, predictability degree is overestimated and does not accurately reflect the occlusion immediately at the end of treatment. In future studies, there should be an effort to broaden the utilization of alternative aligner systems beyond Invisalign® and broadly disseminate their outcomes to strengthen clear aligners evidence base.

Aesthetic perception of smile in long face pattern patients who underwent maxillary impaction with miniplates or orthognathic surgery

INTRODUCTION

The gummy smile is perceived in 10% of the population aged 20 to 30 years old, and it causes an aesthetic imbalance in the smile. This study investigated the existence of differences in the aesthetic perception of the smile after correcting the gummy smile using two different techniques: orthognathic surgery for maxillary impaction and miniplate-aided orthodontic impaction.

METHODS

Photographs of 16 Long Face Pattern female patients were evaluated by 56 oral and maxillofacial surgeons, 56 orthodontists, and 56 laypeople before and after the treatment with one of the two techniques. These photographs were standardized using the Photoshop program, randomly organized, and then presented to the evaluators via the Google Meeting® application in the PowerPoint® program. To evaluate the attractiveness of the smile, the Visual Analogue Scale (VAS) was used. To analyze the intra and inter-examiner concordances, Spearman's correlation and Kendall's concordance tests were used, respectively. For intergroup comparison, the Friedman test was used, with a 5% significance level.

RESULTS

For all three groups of evaluators, the post-treatment evaluation results were superior to the results before the treatment: surgeons and orthodontists assigned higher scores for surgical cases and laypeople for orthodontic cases.

CONCLUSION

From a clinical point of view, there was no difference between the results of both techniques with regard to the aesthetic perception of smiles. A gingival exposure ranging from zero to two millimeters was considered the most aesthetic for all evaluators.

The impact of COVID-19 pandemic on total treatment time of fixed appliances

Background

Several aspects of the orthodontic routine seem to have been affected since the emergence of SARS-CoV-2. We aimed to evaluate the impact of the COVID-19 pandemic on the duration of fixed orthodontic treatment.

Methods

This retrospective study evaluated consecutive cases of patients undergoing fixed orthodontic treatment that completed treatment before (n = 37) or during (n = 26) the COVID-19 pandemic. The impact of the pandemic on treatment time was adjusted for the patient’s initial age, sex, number of debonds/breakages, number of missing teeth, initial PAR (Peer Assessment Rating) index (T0) and operator (n = 2), through multiple linear regression. The impact generated by months of treatment conducted during the pandemic period was also examined. Seven poorly finished cases were previously excluded, including five finished during the pandemic.

Results

Although the number of absences/missed appointments of patients treated during the pandemic was four months more than those treated in the previous period (p < 0.001), there was no significant effect of the pandemic on total orthodontic treatment time for both operators. There was also an effect of operator (β = 10.42, p < 0.001) and gender, which was lower in females (β = 4.77, p = 0.03), on treatment time (R² = 0.27). The other variables showed no significant association (p > 0.05).

Conclusion

The COVID-19 pandemic did not have a significant effect on total orthodontic treatment time, although a greater number of absences/missed appointments were observed.

Effects of a ceramic active self-ligating bracket on retraction/tipping/ rotation of canine, premolar mesialization, and transverse arch dimensions: A preliminary single-blind split-mouth randomized clinical trial

BACKGROUND

There is no clinical study on ceramic self-ligating brackets (SLBs). Therefore, this preliminary study was conducted for the first time to address its effects.

MATERIALS AND METHODS

This split-mouth randomized trial was performed on 32 quadrants in 16 orthodontic patients needing extraction of maxillary premolars and distalization of canines. In each blinded patient, right/left sides were randomized into control (ceramic bracket) and experimental (ceramic SLB) groups. Dental stone models were taken before canine retraction and 3 months into retraction. Models were digitized as three-dimensional models. Changes were measured on superimposed models. Groups were compared using Wilcoxon signed-rank test (α = 0.05, β = 0.1).

RESULTS

Both bracket types caused significant changes after 3 months in terms of all assessed clinical outcomes (P ≤ 0.002). Compared to conventional ceramic brackets (control), ceramic SLBs reduced retraction rate (P = 0.001), canine rotation (P = 0.001), canine tipping (P = 0.002), and arch expansion at the canine site (P = 0.003). However, the extents of anchorage loss (P = 0.796) and arch constriction in the premolar area (P = 0.605) were not statistically different between the bracket types.

CONCLUSION

Compared to conventional metal-lined ceramic brackets, active ceramic SLB can increase the duration of canine distalization, while reducing canine rotation and tipping (inducing more bodily movements). The loss of anchorage with ceramic SLB was similar to that of conventional ceramic bracket after 3 months of treatment (considering the lower rate of SLB canine retraction during that time). Both brackets similarly constricted the arch at the premolar site. In the canine area, they expanded the arch, with the SLB causing smaller extents of expansion.

Rapid Palatal Expansion and Utilization of E-space in Mixed Dentition: Mechanics that Helps in the Corrective Orthodontic Treatment

Aim and objective

The objective of this article was to report two clinical cases, showing the benefits of interceptive treatment using rapid palatal expansion (RPE) and the preservation of E-space.

Background

It is important to follow-up child throughout its development to detect irregularities in their occlusion and to avoid or attenuate orthodontic treatments in the future. Posterior crossbite and transverse maxillary deficiency can easily be corrected by RPE that enhances the width of the maxilla and promotes a gain of space in the arch. Another way to gain space in the arch is by using the E-space, which is the difference between the mesiodistal distance of the second primary molar in relation to the second premolar. This additional space can be used to resolve negative, mild, or moderate crowding.

Case descriptions

Two clinical cases that presented malocclusions due to lack of space and maxillary deficiency, along with clinical technic of how the RPE and E-space can be used to bring those patients back to normality.

Conclusion

We concluded that with a right diagnosis, correct interceptive timing, and using what growth provides, the development can be reestablished.

Clinical significance

The clinical importance of this report is that RPE and E-space are efficient interceptive orthodontic treatments to correct skeletal posterior crossbite (SPC) and gain space in dental arches.

How to cite this article

Lopes BKB, Scheicher GV, Matsumoto MAN, et al. Rapid Palatal Expansion and Utilization of E-space in Mixed Dentition: Mechanics that Helps in the Corrective Orthodontic Treatment. Int J Clin Pediatr Dent 2021;14(1):133–139.

Effects of rapid maxillary expansion or alternating rapid maxillary expansion and constriction on nasal mucociliary clearance : A randomized clinical trial

PURPOSE

This parallel trial aimed to evaluate the changes in nasal mucociliary clearance (MCC) after a rapid maxillary expansion (RME) protocol or an alternating rapid maxillary expansion and constriction (Alt-RAMEC) protocol in orthodontic patients.

METHODS

This trial included 36 patients with a mean age of 14.38 years, with a narrow maxillary arch, bilateral posterior crossbite, no narrowing of the mandibular arch, no previous orthodontic treatment, and no nasal or systemic disease. Patients were randomly distributed into two groups (n = 18 each)-one group was treated with the RME protocol and the other group was treated with the Alt-RAMEC protocol. MCC was evaluated using the saccharine transit time (STT) test, which was measured for each individual before expansion (T0), after expansion (T1), and after a 4-month retention phase (T2). The study was single blinded, and blinding was applied only to the outcome assessor. The primary objective was to evaluate the effect of the Alt-RAMEC and RME protocols on MCC. The secondary objective was to determine the relationship between age, sex, and MCC. The χ ² test and independent samples t‑test were used to evaluate the data.

RESULTS

The STT decreased after expansion and retention in the RME group. In the Alt-RAMEC group, the STT decreased after expansion and slightly increased after retention. When the RME and Alt-RAMEC groups were compared, the STT showed a significant difference after expansion and retention (p < 0.05). No significant relationship was observed between age and sex and STT (p > 0.05).

CONCLUSION

This study demonstrated that the Alt-RAMEC protocol improved MCC and had a positive effect on nasal physiology by increasing the nasal volume more than that achieved by RME.

Phone-based audience response system as an adjunct in orthodontic teaching of undergraduate dental students: a cross-over randomised controlled trial

BACKGROUND

The advent of electronic teaching facilities improves tutor-student communication. This study aims to explore the effectiveness of Phone-Based Audience Response System (PB-ARS), as an adjunctive pedagogy tool to enhance the retention of orthodontic information by dental students; and to explore the students' perception of PB-ARS.

METHODS

This cross-over clustered randomised control trial included 34 males who were in the final year of their undergraduate dental training. Participants were allocated to one of two event groups (G1 and G2) using computer-generated randomisation. Both groups simultaneously attended two different traditional lectures (L 1 and L2) a week apart. During L1, PB-ARS was used as an adjunct to conventional presentation to teach G1 participants, (PB-ARS group) while G2's participants acted as a control group (CG), and were taught using a traditional presentation. In the second week (L2), the interventions were crossed-over. Participants from both groups completed pre- and post-lecture multiple-choice questionnaires (MCQ) to assess their short-term retention of information. Their performance in the final MCQ exam (10 weeks following L2) was tracked to assess the long-term retention of the information. Participants also completed post-lecture questionnaires to evaluate their perceptions.

RESULTS

Twenty-nine and 31 participants from the CG and PB-ARS group completed this trial, respectively. Although 87.5% of students in the PB-ARS group showed an improvement in their immediate post-lecture scores compared with 79.3% for the CG, it was statistically insignificant (p = 0.465). Similarly, the intervention showed an insignificant effect on the long-term retention of the knowledge (p = 0.560). There was a mildly but favourable attitude of students towards the use of PB-ARS. However, the difference in the overall level of satisfaction between both groups was statistically insignificant (p = 0.183).

CONCLUSION

PB-ARS has a minimal and insignificant effect on the short- and long-term retention of orthodontic knowledge by male undergraduate dental students. PB-ARS was the preferred adjunct tool to conventional classroom teaching. Due to the limitations of this trial, a long-term randomised controlled trial with a larger sample size is recommended.

Orthodontists' and patients' perceptions regarding techniques to reduce the orthodontic treatment duration

BACKGROUND

The purpose of this study was to evaluate patients' and orthodontists' perspectives on knowledge of techniques for reducing orthodontic treatment time and acceptance of these techniques.

METHODS

A total of 200 individuals were interviewed and equally divided into two groups: orthodontist group (62 female and 38 male; mean age, 38.07 years) and patient group (52 female and 48 male; mean age, 22.61 years; in the active stage of fixed orthodontic treatment). One questionnaire for each group was administered, including questions about the duration of orthodontic treatment and techniques used for treatment optimization, such as corticotomy, distraction osteogenesis, vibration, and laser therapy. The associations between variables were analyzed by the χ² test at a significance level of 5%.

RESULTS

Among orthodontists, 76% knew at least one technique to reduce the treatment duration, with corticotomy being the most frequently cited (66%); however, only 12% used one or more of these techniques. Laser therapy was the most frequently implemented technique (7%). Regarding the duration of orthodontic treatment, the mean time reported by orthodontists was 19 to 24 months, regardless of the technique or the experience of the orthodontist. Furthermore, 39% of patients expected their treatment to last for more than 24 months, with 50% accepting to undergo further procedures to reduce this duration.

CONCLUSIONS

Patients are willing to undergo additional procedures to reduce the treatment duration and to bear additional costs. However, despite their knowledge, orthodontists do not apply or offer these techniques to the patients.

Effects of different stretching extents, morphologies, and brands on initial force and force decay of orthodontic elastomeric chains: An in vitro study

BACKGROUND

Elastomeric chains are of clinical importance to orthodontics. Therefore, their behavior should be assessed under different conditions. Some of their critical aspects remain unstudied (including effects of different elongations and chain forms on their force properties). Therefore, we aimed to assess these factors.

MATERIALS AND METHODS

This in vitro study was performed on 540 observations: first, 90 chains (10 specimens per subgroup of three brands [American Orthodontics, Ortho Technology (OT), and G&H], each from three chain types [closed, short, and long]) were stretched for three extents (40%, 60%, and 100%) and their forces were measured using a universal testing machine. Afterward, 270 new chains of the same brands/types were stretched for the same extents by installing them onto pairs of pins with different interpin distances. Plates holding pins/chains were incubated in artificial saliva at 37°C for 4 weeks. Afterward, their forces were measured and analyzed using partial correlation coefficient, three-way analysis of variance (ANOVA), Tukey, Student's t, and Mann-Whitney tests (α = 0.001).

RESULTS

Forces degraded significantly from an overall mean of 3.97 ± 0.97 N to 1.29 ± 0.39 N after 4 weeks (all P = 0.000, t-test/Mann-Whitney). ANOVA showed highly significant differences among brands, types, and elongations, in terms of "initial force, force decay, and residual force" (all P = 0.000). Almost all post hoc pairwise comparisons were significant (Tukey P = 0.000). There was a strong positive correlation between elongation extent and force loss (r = 0.846, P = 0.000).

CONCLUSION

OT might be the most preferable brand. Closed chains might usually show better results, especially in OT chains. Instead of using chains half of the size of the space (to elongate for 100%), longer chains should be used to stretch for lesser extents.

Esthetic perception of facial profile changes in Class II patients treated with Herbst or Forsus appliances

OBJECTIVE

To evaluate the esthetic perceptions of orthodontists and laypersons for facial profile changes after orthodontic treatment using Herbst or Forsus appliances.

MATERIALS AND METHODS

Pre- and posttreatment facial profile contour images of 20 Class II patients treated with Herbst (group H; n = 10) and Forsus (group F; n = 10) appliances were analyzed by 30 orthodontists and 30 laypersons, who graded them from 1 (unattractive) to 10 (very attractive) using a visual analog scale. Two assessments were carried out with a 15 day-interval. In the first evaluation, 40 images were presented in a random sequence. In the second evaluation, initial and final facial profile images of each patient were randomly presented side by side. To compare groups in relation to treatment method, Mann-Whitney tests were used. To evaluate differences between time points, Wilcoxon tests were used.

RESULTS

In the first evaluation, there was a significant difference between initial and final images only for group H, for both laypersons (P = .017) and orthodontists (P = .037). There was also a significant difference between laypersons and orthodontists in their ratings of posttreatment Herbst appliance profiles (P = .028). There was no significant difference between initial and final facial profile images for group F and no significant differences between or within evaluator groups in their ratings of initial or final Forsus appliance profiles. In the second evaluation, there was a significant difference between appliance groups only for laypersons, who considered cases treated with the Herbst appliance more attractive than those treated with the Forsus (P = .031). Laypersons also considered Herbst profiles more attractive than did orthodontists (P = .047).

CONCLUSIONS

Class II malocclusion treatment using the Herbst appliance may produce a more esthetically improved facial profile silhouette compared with Forsus appliances. The magnitude of perceived changes may not be considered clinically relevant.

Interception and early treatment with rapid maxillary expansion for the impacted maxillary permanent central incisor in children: Two cases report with 5-years follow-up

INTRODUCTION

The maxillary central incisor impaction represents a complex challenge in paediatric dentistry practice and may result in aesthetic and functional disharmony. The causes of this condition include physical barriers associated or not with a lack of space making eruption not possible, idiopathic ectopic positioning of the teeth or by trauma, non-coordination in rhizalysis and rhizogenesis between deciduous and successor or tooth shape abnormalities. The incidence of this involvement is quite rare, around 1% of the population. Opening of space through disjunction of the palatal suture is the main treatment proposed to solve this situation and, when necessary, the orthodontic traction assisted by surgery.

DESCRIPTION

Were presented two cases of maxillary central incisors impaction in children treated with rapid maxillary expansion, alignment and levelling, and a follow-up after 5 years of treatment.

RESULTS AND CONCLUSIONS

The challenge of these treatments were based on the early treatment in mixed dentition with expansion. The treatment of permanent maxillary central incisor impaction in children enabled excellent periodontal response and post-treatment occlusal stability.

Tomographic evaluation of dentoskeletal changes due to the treatment of class II malocclusion with Forsus appliance

Purpose

This study evaluated dentoalveolar skeletal changes promoted by the Forsus appliance, associated to fixed orthodontic appliance, in the correction of Class II, division 1 malocclusion, from Computed Tomography (CT).

Methods

sample consisted of 10 youngsters (7 males and 3 females), with a mean age of 13.86 years. Two Forsus^® models were installed after the alignment and leveling phase of the teeth. Two tomographic images of each patient, T1 and T2 (initial and immediately after removal of Forsus^® appliance) were done to perform the anatomical tracings and obtain the variables of interest. The data were described by means and standard deviations. For the comparison between the initial and final phases, the paired "t" test was used and a significance level of 5% was considered (p < 0.05).

Results

small skeletal changes were observed, such as posterior maxillary displacement and a slight mandibular growth. Larger dentoalveolar changes occurred as extrusion, retrusion and lingualization of upper incisors; Intrusion, protrusion and vestibularization of the lower incisors; Mesialization and extrusion of lower molars.

Conclusion

Considering the patients evaluated in this study, Forsus^® presented similar results to other mandibular propulsion appliances, with dentoalveolar effects that favored Class II correction, however, with very slight skeletal modifications.

The association between patient's compliance and age with the bonding failure of orthodontic brackets: a cross-sectional study

Background

An efficient orthodontic treatment must aim the best occlusal result in the shortest possible time. One of the factors that can interfere in this goal is the bracket debonding during the treatment. This study aimed at assessing the different factors related to brackets failure, highlighting age and patient cooperation with treatment.

Methods

The sample comprised 199 orthodontic patients of both genders (103 women and 96 men); divided into two groups—adolescents (12 to 18 years old, 118 patients) and adults (19 to 59 years old, 81 patients). A questionnaire was applied regarding the motivation of patients to seek treatment and whether they had received information on appliance care; patients also filled out their level of cooperation with treatment in a visual analog scale (VAS). Additionally, other variables were assessed, such as the teeth with bracket debonding, the presence of deep overbite, and the use of bite plate. The Mann-Whitney test was used, and a 5% significance level was applied for analyses.

Results

It was observed that 20.1% of patients presented at least one tooth with bracket failure, and the lower arch was the most prevalent site (47.5%). Adolescents presented more debonding (25.4%) than adults (12.3%). Individuals with better VAS scores on cooperation sought treatment on their own (p = 0.042), were adults (p ≤ 0.001), and showed lower rate of failure of brackets (p ≤ 0.001). The factors related to malocclusion and treatment performed had no statistical significance.

Conclusion

Greater cooperation was expected from adult individuals who sought treatment on their own and presented low rate of bracket failure.

Extreme skeletal open bite correction with vertical elastics

Severe skeletal open bites may be ideally treated with a combined surgical-orthodontic approach. Alternatively, compensations may be planned to camouflage the malocclusion with orthodontics alone. This case report describes the treatment of an 18-year-old man who presented with a severe open bite involving the anterior and posterior teeth up to the first molars, increased vertical dimension, bilateral Class III molar relationship, bilateral posterior crossbite, dental midline deviation, and absence of the maxillary right canine and the mandibular left first premolar. A treatment plan including the extraction of the mandibular right first premolar and based on uprighting and vertical control of the posterior teeth, combined with extrusion of the anterior teeth using multiloop edgewise archwire mechanics and elastics was chosen. After 6 months of alignment and 2 months of multiloop edgewise archwire mechanics, the open bite was significantly reduced. After 24 months of treatment, anterior teeth extrusion, posterior teeth intrusion, and counterclockwise mandibular rotation were accomplished. Satisfactory improvement of the overbite, overjet, sagittal malocclusion, and facial appearance were achieved. The mechanics used in this clinical case demonstrated good and stable results for open-bite correction at the 2-year posttreatment follow-up.

Influence of temperature and humidity on the long-term storage of latex and non-latex orthodontic elastics

OBJECTIVES

The objective of this study was to evaluate the influence of long-term storage on latex and non-latex orthodontic elastics.

MATERIALS AND METHODS

The sample consisted of 300 orthodontic elastics, 150 latex and 150 non-latex (American Orthodontics^® *(AO) and Morelli^®) of medium force and a standard size of 3/16'' divided into 20 groups, 10 for each manufacturer, with 15 specimens each. The groups (G1*-G10* and G1-G10) were made up based on the manufacturer, storage temperature (ambient and refrigerated), material, and ambient humidity (exposed and non-exposed). The elastics were stretched and their forces measured in five progressive increases of 100% of their inner diameter, starting at a level of 200% stretching, by the MESDAN LAB 3000^® (MESDAN, Italy) testing machine. The tests were carried out at two different times: immediately in as-received state and again after 1 year. Data were analysed using SPSS 16.0 software, the Student's t-test, one-way analysis of variance (ANOVA) and the Tukey's post-test.

RESULTS

There was a statistically significant difference between the average forces exerted by the latex elastics compared to the non-latex elastics for all distention levels evaluated, except for 300%; however, the different storage conditions of temperature and humidity did not interfere in the mechanical properties.

CONCLUSION

Both the latex and non-latex elastics may be stored under any of the conditions tested in the present study, since there were no changes in the potential of the force exerted by the elastics in relation to their percentage stretch over a 1-year period.

Comparative cephalometric study of Class II malocclusion treatment with Pendulum and Jones jig appliances followed by fixed corrective orthodontics

OBJECTIVE

The purpose of this study was to cephalometrically compare the skeletal and dentoalveolar effects in the treatment of Class II malocclusion with Pendulum and Jones jig appliances, followed by fixed corrective orthodontics, and to compare such effects to a control group.

METHODS

The sample was divided into three groups. Group 1: 18 patients treated with Pendulum, Group 2: 25 patients treated with Jones jig, and Group 3: 19 young subjects with untreated Class II malocclusions and initial mean age of 12.88 years. The chi-square test was applied to assess severity and gender distribution. Groups 1 and 2 were compared to the control group by means of the one-way ANOVA and Tukey tests in order to differentiate treatment changes from those occurred by craniofacial growth.

RESULTS

There were no significant changes among the three groups with regard to the components of the maxilla and the mandible, maxillomandibular relationship, cephalometric and tegumental pattern. Buccal tipping of mandibular incisors was significantly greater in the experimental groups and increased mesial angulation of the maxillary second molars was found in the Jones jig group. In the experimental groups, dental relationship, overbite and overjet were corrected.

CONCLUSIONS

It can be stated that the distalization achieved its purpose of correcting the Class II.

Comparative study on direct and indirect bracket bonding techniques regarding time length and bracket detachment

OBJECTIVE

The aim of this study was to assess the time spent for direct (DBB - direct bracket bonding) and indirect (IBB - indirect bracket bonding) bracket bonding techniques. The time length of laboratorial (IBB) and clinical steps (DBB and IBB) as well as the prevalence of loose bracket after a 24-week follow-up were evaluated.

METHODS

Seventeen patients (7 men and 10 women) with a mean age of 21 years, requiring orthodontic treatment were selected for this study. A total of 304 brackets was used (151 DBB and 153 IBB). The same bracket type and bonding material were used in both groups. Data were submitted to statistical analysis by Wilcoxon non-parametric test at 5% level of significance.

RESULTS

Considering the total time length, the IBB technique was more time-consuming than the DBB (p < 0.001). However, considering only the clinical phase, the IBB took less time than the DBB (p < 0.001). There was no significant difference (p = 0.910) for the time spent during laboratorial positioning of the brackets and clinical session for IBB in comparison to the clinical procedure for DBB. Additionally, no difference was found as for the prevalence of loose bracket between both groups.

CONCLUSIONS

The IBB can be suggested as a valid clinical procedure since the clinical session was faster and the total time spent for laboratorial positioning of the brackets and clinical procedure was similar to that of DBB. In addition, both approaches resulted in similar frequency of loose brackets.

Dental transposition of canine and lateral incisor and impacted central incisor treatment: a case report

Introduction

Dental transposition and impaction are disorders related to ectopic eruption or failure in tooth eruption, which can affect child physical, mental and social development and may be difficult to be clinically solved.

Methods

We describe a case of transposition between the upper left canine and lateral incisor associated with impaction of the central incisor on the same side, in a 12-year-old patient. Conservative treatment involving surgical-orthodontic correction of transposed teeth and traction of the central incisor was conducted.

Conclusion

The option of correcting transposition and orthodontic traction by means of the segmented arch technique with devices such as cantilever and TMA rectangular wire loops, although a complex alternative, was proved to be esthetically and functionally effective.

Compensatory orthodontic treatment of skeletal Class III malocclusion with anterior crossbite

INTRODUCTION

This case report describes the orthodontic treatment of an adult patient with skeletal Class III malocclusion and anterior crossbite. A short cranial base led to difficulties in establishing a cephalometric diagnosis. The patient's main complaint comprised esthetics of his smile and difficulties in mastication.

METHODS

The patient did not have the maxillary first premolars and refused orthognathic surgery. Therefore, the treatment chosen was orthodontic camouflage and extraction of mandibular first premolars. For maxillary retraction, the vertical dimension was temporarily increased to avoid obstacles to orthodontic movement.

RESULTS

At the end of the treatment, ideal overjet and overbite were achieved.

CONCLUSIONS

Examination eight years after orthodontic treatment revealed adequate clinical stability. This case report was submitted to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) as part of the requirements to become a BBO diplomate.

Treatment of dental and skeletal bimaxillary protrusion in patient with Angle Class I malocclusion

In the orthodontic clinic, skeletal and dental bimaxillary protrusion is presented frequently as one of the factors leading patients to seek orthodontic treatment, mainly due to the esthetic involvement it has. The patient of this article illustrates this situation, being deeply uncomfortable with her esthetic appearance, due to the excessive upper incisors exposure and problems with lip sealing. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO), as part of the requisites to become a BBO Diplomate.

Transversal changes in dental arches from non-extraction treatment with self ligating brackets

OBJECTIVE

The present study aimed at analyzing, with the use of dental casts, the transverse changes of the upper and lower dental arches, after non-extraction orthodontic treatment, with self-ligating brackets.

METHODS

The sample comprised 29 patients, all presenting Class I malocclusion with upper and lower crowding of at least 4 mm and treated only with a fixed appliance, without stripping, extraction or distalization. The dental casts were obtained before and after leveling with 0.019 x 0.025-in stainless steel archwires.

CONCLUSIONS

The results indicated that the majority of transverse changes occurred at the premolar areas, both the first and the second, as well as on the upper and lower dental arches. The intercanine distance increased 0.75 mm, on average, in the upper arch and 1.96 mm in the lower arch. The molars also demonstrated a tendency towards an increase in their transverse dimension, however, at a lower intensity comparing to premolars. All measurements presented statistically significant differences with the exception of the maxillary second molars.

Riding pontic: a tool to keep patients smiling

All patients expect a beautiful smile at the completion of orthodontic treatment, but some patients show concern regarding their appearance while undergoing treatment. The appearance of a gap from a missing tooth can be a concern, especially if it is in the display zone of a patient's smile. If the treatment plan includes prosthetic replacement of the missing tooth rather then space closure, then space maintenance is also an issue. In an appearance conscious patient use of riding pontic as space maintainers is a good option during treatment.

How to cite this article: Sharma NS. Riding Pontic: A Tool to Keep Patients Smiling. Int J Clin Pediatr Dent 2013;6(2): 127-131.

Angle Class I malocclusion with anterior open bite treated with extraction of permanent teeth

This clinical case reports the orthodontic treatment of a Class I malocclusion with anterior open bite and bimaxillary dentoalveolar protrusion in a 28-year-old female patient. The treatment of choice was to perform tooth extractions followed by retraction of the anterior teeth, with consequent closure of the anterior open bite and better accommodation of the teeth on their bony bases. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO), representing the Category 2 -- i.e., an Angle Class I malocclusion, with anterior open bite, treated with extraction of permanent teeth --, as part of the requisites to become a BBO diplomate.

Class II malocclusion treatment using Jasper Jumper appliance associated to intermaxillary elastics: a case report

INTRODUCTION

Skeletal, dental and profile discrepancies can be amended by using functional orthodontic appliances.

OBJECTIVE

This study is a report of the treatment of a patient, 11 years and 4 months old, with Class II, division 1, malocclusion, convex profile, protrusion of upper incisors, pronounced overjet and overbite, and mild crowding.

METHODS

The patient was treated with a Jasper Jumper associated to fixed appliances for 6 months and Class II intermaxillary elastics (3/16-in) during the last 4 months. After debonding, a Hawley retainer was used during daytime and a modified Bionator for night use during one year. In the lower dental arch a bonded lingual retainer was used. This treatment combination improved the profile, as well as the overjet, overbite and molar relation.

RESULTS

There was clockwise mandibular rotation and increase of lower anterior facial height. The lower incisors were protruded and extruded and the lower molars were extruded. The centric occlusal relation was checked and it was coincident to the maximum usual intercuspation.

CONCLUSIONS

It was demonstrated that the Jasper Jumper is an efficient alternative to Class II malocclusion treatment, providing improvement in the facial profile, although the changes are more dentoalveolar than skeletal.

Stability of molar relationship after non-extraction Class II malocclusion treatment

OBJECTIVE

This study aimed to evaluate the stability of molar relationship after non-extraction treatment of Class II malocclusion.

METHODS

The sample comprised 39 subjects (16 females, 23 males) with initial Class II malocclusion treated with no extractions, using fixed appliances. Mean age at the beginning of treatment was 12.94 years, at the end of treatment was 15.14 years and at post-retention stage was 21.18 years. Mean treatment time was 2.19 years and mean time of post-treatment evaluation was 6.12 years. To verify the influence of the severity of initial Class II molar relationship in stability of molar relationship, the sample was divided into two groups, one presenting a ½-cusp or ¾-cusp Class II molar relationship, and the other with full-cusp Class II molar relationship. In dental casts from initial, final and post-retention stages, molar, first and second premolars and canine relationships were measured. Data obtained were analyzed by dependent ANOVA, Tukey and Pearson's correlation tests, as well as independent t test between the two groups divided by severity of initial molar relationship.

RESULTS

There was a non-statistically significant 0.12-mm relapse of molar relationship. The initial severity of Class II molar relationship was not correlated to relapse in the post-retention period. When compared, the two groups showed no difference in relapse of molar relationship.

CONCLUSIONS

It was concluded that correction of Class II molar relationship is stable and initial severity does not influence relapse of molar relationship.

Miniscrew-supported coil spring for molar uprighting: description

INTRODUCTION

Since the beginning of miniscrews as orthodontic anchorage, many applications have been described in the literature. Among these, one is the uprighting of mesially inclined molars. In regard to the mechanical aspects, however, there is little information about the application of orthodontic forces using such devices.

OBJECTIVE

The objective of this study was to describe a miniscrew supported spring for uprighting of mesially inclined molars. With this device, one can achieve the correct use of orthodontic biomechanics, thus favoring more predictable tooth movements and preventing unwanted movements from occurring.

Does self-ligating brackets type influence the hysteresis, activation and deactivation forces of superelastic NiTi archwires?

OBJECTIVE

To compare hysteresis, activation and deactivation forces produced by first-order deformation of Contour 0.014-in NiTi wire (Aditek, Brazil) in four brands of self-ligating brackets: Damon MX, Easy Clip, Smart Clip and In-Ovation.

METHODS

Activation and deactivation forces were measured in an Instron universal tensile machine at 3 mm/minute speed to a total displacement of 4 mm. Tests were repeated eight times for each bracket/wire combination. Statistical analysis comprised ANOVA and Tukey's multiple comparisons test.

RESULTS

Using a 4-mm deformation, mean activation forces increased in the following order: Damon = 222 gf, Easy Clip = 228 gf, In-Ovation = 240 gf and Smart Clip = 306 gf. The same order was observed for mean hysteresis values, i.e., 128 gf, 140 gf, 150 gf and 206 gf, respectively. The respective values of deactivation forces for the Damon, Easy Clip, In-Ovation and Smart Clip brackets were 94 gf, 88 gf, 90 gf and 100 gf.

CONCLUSIONS

Brackets with higher activation forces were accompanied by higher hysteresis values, which resulted in clinically similar deactivation forces, regardless of the type of self-ligating brackets used.