v. 16, no. 4
Dental Press Journal of Orthodontics – ISSN 2176-9451
Dental Press J. Orthod.
v. 16, no. 4
July / August
Generation Z and the evolution of scientific journals
During his lifetime, Charles Darwin sent at least 7,591 letters and received 6,530. Albert Einstein, in turn, sent over 14,500 and received more than 16,200.1 This means that they wrote, respectively, 0.59 and 1.02 letters every day in the last 30 years of their lives. Such impressive display of discipline compels one to imagine that the number of messages exchanged by them would be particularly astronomical if they had lived in the age of email and social networks. In 2010, it is estimated that in emails only, excluding spam, approximately 4.5 messages were sent out worldwide per day per capita.2
This increase in human interaction has forcibly reduced messages size. So much so that the golden rule of email etiquette demands briefness and conciseness.3 This increasing shrinkage of exchanged messages is among the factors that set the stage for the success of social networks. Prolixity would never have allowed this phenomenon to emerge. In virtual environments information is transferred swiftly, often deploying resources that go beyond the written word. Ideas ? both good and bad ? are spread through words, images, videos and sounds, which can be used in isolation or not.
The internet and social networks have brought to light several simultaneous phenomena. Among these is the so-called Generation Z, which shares information in a compartmentalized manner as if each compartment was but a piece of the overall puzzle. No one is interested in assembling the whole puzzle. People just want to separate the parts that arouse their interest and provides themselves with the desired knowledge. Thus, consistency between the parts is not given by textual elements but by individual curiosity, the specific interest of each person.
That?s why long informative texts have become so boring. Extracting meaningful content simply takes too long. It is a matter of cost-benefit. Why spend time trying to grasp what could be learned in minutes?
These selection pressures led to the evolution of a wide range of hardware and software technologies. To cite just one example, most current mobile phones ? which have been expanded into tablets ? were developed to meet the need for this information flow. They are not just phones. They give access to social networks, restaurant guides, GPS, email, games, etc. They are mini entertainment and communication centers.
Generation Z has never envisioned the planet without computers, chats, mobile phones. Their mindset was influenced from birth by a fast-track, complex world materialized by technology and they, therefore, conceive of a world devoid of geographical boundaries. They have reached the age of consumer decisions. They consume video games, but also cars, real estate, e-books and, obviously, scientific literature.
All these selection pressures have come into play in the area of scientific journals, and are bound to keep pushing harder and harder. Whoever fails to keep track of this obvious reality is doomed to extinction.
We at the Dental Press Journal of Orthodontics are at the forefront of the teaching-learning process. We have become the first scientific journal of orthodontics available worldwide on the iPad. We can be proud of producing one of today?s best graphic design, as well as versatility, in formatting published articles. However, we will certainly keep on evolving.
To be accepted, articles will have to limit the number of words to 3,500, including title, abstract and references. Authors are encouraged to utilize a wealth of multimedia resources and use the power of the Dental Press Portal to tap into these resources. Information not essential to the understanding of the article will be appended on the web, shedding light on key content. We will further strengthen the importance of clinical information by including a section in the article entitled Clinical Relevance. In this new section, authors will be able to highlight the key points in their study that can somehow improve clinical practice. Something along the lines of ?evidence-based clinical tips.? Finally, the authors will be encouraged to prepare questions for inclusion in the online version of their article. The goal is to give readers the chance to test their knowledge while encouraging teachers in undergraduate and graduate courses to expose their students to these themes.
Einstein once said that ?it is important never to stop questioning.? Only then can we truly evolve and accomplish something that really makes a difference.
What´s new in Dentistry
Orthodontic records: new aspects of an old concern
The concept of root resorptions or Root resorptions are not multifactorial, complex, controversial or polemical!
Interview with Tiziano Baccetti
? Assistant Professor and Researcher, Department of Orthodontics, University of
Florence, Florence, Italy.
? Full Professor, Dentofacial Orthopedics, School of Dentistry, University of Florence,
? T.M. Graber Visiting Professor, Department of Orthodontics and Pediatric Dentistry,
University of Michigan, Ann Harbor, MI.
? Ad hoc reviewer of the following journals: Angle Orthodontist, American Journal
of Orthodontics and Dentofacial Orthopedics, European Journal of Orthodontics,
Journal of Clinical Periodontology, Journal of Biomechanics, European Journal of
Oral Sciences, Orthodontics and Dentofacial Research.
? Associate Editor of Progress in Orthodontics.
Decodify® System: Cephalometrics as a risk manager applicative and administrative tool for the orthodontic clinic
Introduction: Cephalometrics may have limited use in orthodontics because of its subjective interpretation. An Artificial Intelligence (AI) system, the Decodify® System, was developed to allow the customized quantitative assessment of contextualized cephalometric data. In this article, the system is tested as an administrative tool in orthodontic offices.
Methods: The development of algorithms includes the norms and standard deviations modeling of Brazilians? cephalometric data, measured in lateral radiographs. In order to test the system, initial cephalograms of 60 orthodontic patients of two different orthodontic offices (30 cases each) were processed and re-processed by three different technicians. The intra-observer and inter-observer reproducibility and reliability indices were checked by paired comparisons. The risk in each orthodontic case, assessed by the electronic analysis, was compared by covariance matrices and agreement coefficients.
Results: Levels of paired agreement inter-observers (versus golden-pattern) for 23 pairs of variables ranged from 0.68 (S-Go distance) to 0.98 (Na-Me distance) in an orthodontic clinic (JU) and from 0.66 (L1.APg angle) to 0.98 (S-Go distance) in the other (SP). All the correlations were significant at the p<0.001 level. The average of the agreement coefficients was 0.78 for one clinic (JU) and 0.75 for the other (SP). The agreement coefficients were significant at the p<0.001 level.
Conclusions: The results of such research support that the analyses provided by the Decodify® System are reproducible and reliable. Therefore, the system can be applied in order to contextualize conventional cephalometric measurements and to generate individualized risk indices. The system may be used by orthodontists as an administrative tool in the daily professional evaluations.
Influence of the cross-section of orthodontic wires on the surface friction of self-ligating brackets
Objectives: The purpose of this study was to assess the surface friction produced between selfligating stainless steel brackets equipped with a resilient closure system and round and rectangular orthodontic wires made from the same material.
Methods: Thirty maxillary canine brackets were divided into six groups comprising Smartclip and In-Ovation R self-ligating brackets, and conventional Gemini brackets tied with elastomeric ligatures. This investigation tested the hypothesis that self-ligating brackets are susceptible to increases in friction that are commensurate with increases and changes in the cross-section of orthodontic wires. Traction tests were performed with the aid of thirty segments of 0.020-in and 0.019 x 0.025-in stainless steel wires in an Emic DL 10000 testing machine with a 2N load cell. Each set of bracket/wire generated four samples, totaling 120 readings. Comparisons between means were performed using analysis of variance (one way ANOVA) corrected with the Bonferroni coefficient.
Results and Conclusion: The self-ligating brackets exhibited lower friction than conventional brackets tied with elastomeric ligatures. The Smartclip group was the most effective in controlling friction (p<0.01). The hypothesis under test was confirmed to the extent that the traction performed with rectangular 0.019 x 0.025-in cross-section wires resulted in higher friction forces than those observed in the 0.020-in round wire groups (p<0.01). The Smartclip system was more effective even when the traction produced by rectangular wires was compared with the In-Ovation R brackets combined with round wires (p<0.01).
Orthodontists? and laypersons? perception of mandibular asymmetries
Facial asymmetries. Mandible. Perception. Orthodontics.
Objective: To analyze orthodontists? and laypersons? perceptions of facial asymmetries caused by mandibular changes.
Methods: The faces of two patients, a man and a woman, were photographed in natural head position, and additional photographs were produced with progressive mandibular shifts of 2, 4 and 6 mm from maximum habitual intercuspation (MHI). Intraclass correlation coefficients (ICC) and weighted kappa coefficients were used to test method reproducibility. The differences in scores for mandibular positions between orthodontists and laypersons were examined using Friedman analysis. All statistical analyses were performed at 95% confidence interval.
Results: Orthodontists only perceived shifts greater than 4 mm from MHI position (p<0.05), and laypersons had similar results when analyzing the woman?s photographs. However, when examining the man?s photographs, laypersons did not perceive any change in relation to MHI (p>0.05). Although median scores assigned by orthodontists were, in general, lower than those of laypersons, this difference was only significant for the 6-mm shift in both patients.
Conclusions: Orthodontists and laypersons evaluated mandibular asymmetries differently. Orthodontists tended to be more critical when asymmetries were more severe. The evaluation of facial asymmetries also varied according to what patient was being examined, particularly among lay examiners.
Friction force on brackets generated by stainless steel wire and superelastic wires with and without IonGuard
Objective: The aim of this study was to evaluate the friction forces on brackets (Roth, Composite, 10.17.005, 3.2 mm, width 0.022x0.030-in, torque -2º and angulation +13º, Morelli®, Brazil), with stainless steel orthodontic rectangular wire (Morelli®, Brazil) and nickel-titanium superelastic Bioforce wires with and without IonGuard (Bioforce, GAC®, USA).
Methods: Twenty-four brackets/segment of wire combinations were used, distributed into 3 groups according to the orthodontic wire. Each bracket/segment of wire combination was tested 3 times. The tests were performed in a universal testing machine Emic DL2000®. The data was submitted to ANOVA one way followed by Tukey?s post hoc test (p<0.05).
Results: The rectangular orthodontic Bioforce wire with IonGuard presented significantly lower resistance to sliding than Bioforce without IonGuard. There was no statistical difference among the other groups. However, the coefficient of variation of Bioforce with and without IonGuard was lower than that of the stainless steel wire.
Conclusion: The rectangular orthodontic Bioforce wire with IonGuard presented lower resistance to sliding than Bioforce without IonGuard, with no difference to the stainless steel wire.
Comparison of periodontal parameters after the use of orthodontic multi-stranded wire retainers and modified retainers
Objective: The objective of the present study was to compare two types of fixed orthodontic retainers (a multi-stranded wire retainer and a modified retainer) in relation to established periodontal parameters. The multi-stranded wire retainer is commonly used, and the modified retainer has bends to enable free access of dental floss to interproximal areas.
Methods: For this cross-over study, 12 volunteers were selected and used the following retainers for six months: (A) a multi-stranded wire retainer and (B) a modified retainer. Both retainers were fixed to all anterior lower teeth. After this experimental period, the following evaluations were made: Dental Plaque Index, Gingival Index, Dental Calculus Index and Retainer Wire Calculus Index. The volunteers also responded to a questionnaire about the use, comfort and hygiene of the retainers.
Results: It was observed that the plaque index and the gingival index were higher on the lingual surface (p<0.05) for the modified retainer. Furthermore, the calculus index was statistically higher (p<0.05) for the lingual and proximal surfaces when using the modified retainer. The retainer wire calculus index values were also significantly higher (p<0.05) for the modified retainer. In the questionnaire, 58% of the volunteers considered the modified retainer to be less comfortable and 54% of them preferred the multi-stranded wire retainer.
Conclusion: From the results obtained, it could be concluded that the multi-stranded wire retainer showed better results than the modified retainer according to the periodontal parameters evaluated, as well as providing greater comfort and being the retainer preferred by the volunteers.
Histological evaluation of the phenobarbital (Gardenal?) influence on orthodontic movement: a study in rabbits
Introduction: The purpose of this study was to histologically evaluate the influence of phenobarbital on orthodontic tooth movement.
Methods: Twenty-two New Zealand rabbits (Oryctolagus cuniculus) were divided into three groups: normal or non-tested (N), control (C), and experimental (E). In Group N (n = 2) no procedure was carried out, except to verify the condition of normality before treatment. In Groups C (n = 10) and E (n = 10) an orthodontic appliance was inserted between the first molars and lower incisors in order to promote a mesial molar movement. In Group E phenobarbital was administered during the course of the experiment, which differentiates it from the group C. The animals were sacrificed on days 7 and 14 so that anatomical sections could be prepared for further histological analysis.
Results: Histologically no difference was observed between normal and experimental groups.
Conclusions: Phenobarbital does not interfere with the orthodontic tooth movement.
A new stainless steel wire for orthodontic purposes
Objective: To develop a method to manufacture austenitic-ferritic stainless steel orthodontic wires (SEW 410 Nr. 14517) using conventional rolling and wiredrawing processes.
Methods: Austenitic-ferritic steel was produced in an induction furnace. Tensile tests and microhardness measurements were used to evaluate the wires quality. Orthodontic components were fabricated to assess ductility and malleability.
Results and Conclusions: Austenitic-ferritic stainless steel wires meet the BS 3507:1976 and ISO 5832-1 standards and have excellent ductility for the fabrication of orthodontic parts with complex folds.
Agreement among orthodontists regarding facial pattern diagnosis
Objective: To assess agreement among orthodontists trained in facial pattern diagnosis through the morphological evaluation of the face.
Methods: Facial photographs were taken in front and side views, as well as photographs of the smiles of 105 individuals randomly selected among patients seeking orthodontic treatment. The photographs were sent to orthodontists trained in facial pattern classification. Intra-rater agreement, agreement between raters and the Gold Standard, as well as inter-rater agreement were assessed using the Kappa index.
Results: Intra-rater agreement was almost perfect, with Kappa index reaching 0.85. Agreement between raters and the Gold Standard was moderate (Kappa = 0.48), higher for Pattern I (Kappa = 0.62) and lower for the Short Face Pattern (Kappa = 0.33). Agreement between raters was significant (Kappa = 0.61) and even higher than agreement with the Gold Standard for all patterns.
Conclusions: The criteria used by raters to determine the facial pattern were the same in the first and second evaluation. Agreement between raters and the Gold Standard was moderate, with raters exhibiting greater agreement between them than with the Gold Standard.
Shear bond strength evaluation of metallic brackets using self-etching system
Methods: A total of 64 bovine teeth were divided in four groups and prepared to receive the brackets. Initially (T1), 7 self-etching primer blisters were activated and used to bond the brackets of group I. The blisters were stored at a constant temperature of 4ºC for 2 (T2), 5 (T3) and 9 (T4) days and used to bond the brackets of groups II, III and IV, respectively.
Results: No statistic difference was found in shear bond strength comparing groups I, II and III. However, a significant difference was found in group IV.
Conclusion: The shear bond strength seems not to be affected by activation and storage of the self-etching primer at a mean temperature of 4°C for a 5 day period. More studies are necessary to evaluate other characteristics of the material after its activation and storage for long periods of time.
GCS expansion appliance: Fixed-removable expander
Association between malpositioned teeth and periodontal disease
Methods: The sample comprised 90 individuals aged 15 to 69 years. First, each participant was examined to identify the types of abnormal tooth positions by means of visual inspection. After that, their periodontal health was assessed according to the following clinical parameters: Gingival bleeding on probing, periodontal attachment loss, and probing depth. In bivariate analysis, a chi-square test was used to calculate significance of the associations.
Results: Several types of changes in tooth position were detected in the participants, and the most significant were: Rotated teeth (86.7%); crowding (52.2%); and mesially tipped molar (48.9%). All participants had periodontal changes associated with these abnormalities: 100% had gingival bleeding; 67.8%, gingival recession; 54.4%, gingival enlargement; and 28.9%, chronic periodontitis. There were significant associations between gingival recession and the variables buccally tipped tooth and excessive proclination of maxillary incisors, and also between chronic periodontitis and mesially tipped molar, crowding, excessive proclination of maxillary and mandibular incisors, and diastema (p<0.05). The need of multidisciplinary treatment was clear in all the cases.
Conclusions: Malpositioned teeth negatively affected the health of periodontal tissues, which draws attention to the importance of a multidisciplinary approach that includes, primarily, periodontal and orthodontic care to improve the oral health of patients.
Effects of low intensity laser on pain sensitivity during orthodontic movement
Methods: Twelve patients in need of canine retraction were selected. The canines were retracted with closed NiTi coil springs activated to 150 g per side. One canine of each patient was randomly selected for laser irradiation immediately after activation and after 3 and 7 days. The contralateral canines were taken as control group and were submitted only to simulation of laser application. Diode laser (ArGaAl) was employed at wavelength of 780 nm, power of 20 mW and energy density in the target tissue of 5 J/cm2, for 10 seconds per point, delivering an energy of 0.2 J per point and total energy (TE) of 2 J. The analgesic effect was evaluated with aid of a visual analogue scale (VAS), on which the patients indicated 0 to 10 according to the pain experienced at 12, 24, 48 and 72 hours after coil spring activation and laser application. The procedure was repeated after one month, upon reactivation of canine retraction.
Results and Conclusions: There was no statistically significant difference between irradiated side (LG) and control side (CG). Thus, utilization of infrared diode laser (780 nm) according to the present protocol was not statistically effective to reduce pain sensitivity caused by orthodontic movement.
Muscle pain intensity of patients with myofascial pain with different additional diagnoses
Methods: The sample was comprised by 203 consecutive patients, mean age of 40.3 years (89.2% of females), primarily diagnosed with MFP, who presented to the UCLA Orofacial Pain Clinic. Patients with secondary diagnosis of migraine (n=83) were included and comprised group 2. In order to compare group 1 (MFP) with group 2 (MFP + migraine) regarding objective (palpation scores) and subjective pain levels by means of visual analog scales (VAS). Also, comparisons of mood problems, jaw function problems, sleep quality and disability levels using VAS were performed using the Mann-Whitney test. A significance level of 5% was adopted.
Results: Mann-Whitney test revealed that group 2 presented significantly higher pain levels on palpation of masticatory and cervical muscles in comparison to group 1 (p<0.05). Group 2 also presented higher levels of subjective pain, with statistical significance for ?pain at the moment? and ?highest pain? (p<0.05). Additionally, group 2 showed higher levels of mood problems, disability, jaw function impairment and sleep problems than group 1 with statistical significance for the later (p<0.05).
Conclusions: Migraine comorbidity demonstrated a significant impact on pain intensity and life quality of patients with MFP. Clinicians should approach both conditions in order to achieve better treatment outcomes.
Biometric study of human teeth*
Tooth dimensions. Tooth proportions. Tooth size.
Objectives: To determine the biometric dimensions of human teeth in the mesiodistal, buccolingual and occlusal/incisal-cervical directions.
Methods: It was used a sample of dental casts from 57 patients, i.e., 31 females with a mean age of 15 years and 5 months, and 26 males with a mean age of 16 years and 6 months. The sample was previously qualified by adopting the criteria established by Andrews? six keys to normal occlusion, whose values were matched to the variations obtained by Bolton. Two examiners used a digital caliper with original (short) and modified (long) tips.
Results and Conclusions: After statistical analysis of the data it was concluded that the teeth were shown to be symmetrical in the dental arches of both genders. Tooth dimensions are smaller in females than in males and should therefore be studied separately. Overall mean values were obtained and used to build tables distinguishing such dimensions according to gender. Mean values for the three tooth dimensions, occurrence rates of these dimensions and their standard deviations were also calculated. These values allowed the development of an equation called ?C? equation as well as ?C? percentile tables. With the aid of both, it became possible to measure only one dimension of a given tooth to find the other two ?probable? dimensions of the other teeth in the dental arches.
Prevalence of malocclusion in children aged 7 to 12 years
Objectives: To determine the prevalence of malocclusion in a group of 3,466 children aged 7 to 12 years enrolled in public schools in the cities of Lins and Promissão, in the state of São Paulo, Brazil.
Methods: The sagittal relationships between dental arches, the transverse relationship between arches, and the vertical and horizontal relations of incisors were analyzed. 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.