Dental Press Jounal of Orthodontics
Dental Press International

v. 15, no. 6

Dental Press Journal of Orthodontics – ISSN 2176-9451

Dental Press J. Orthod.

v. 15, no. 6

November / December



The impact of orthodontics on society

Jorge Faber

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What is the impact of orthodontics on society? This question is often addressed to specialties whose goals are, at least in part, aesthetic. We orthodontists are intuitively aware that orthodontic treatment reaches beyond the realm of beauty. A great many patients clearly understand the relevance and scope of orthodontic correction because they enjoy its benefits firsthand in their everyday life.

Cleft patients are among those people. And it is curious to note that Brazil has contributed immensely to the development of techniques and concepts used in the treatment of this pathology since one of the largest and most highly reputed centers in the world for treatment of cleft patients is called “Centrinho” (Little Center), and is located in the city of Bauru, Sao Paulo State (USP-HRAC). It was there that in the 1970s a team of researchers was challenged to expand their knowledge of orthodontic solutions for people who sought them with serious aesthetic and functional facial impairments. Perhaps as a result of this selection pressure, a classic case of ‘professional Darwinism’, several great professionals emerged. I’d like to highlight one such example because he is our interviewee in this edition of the Journal: Dr. Leopoldino Capelozza Filho, or simply, Dino, as he is fondly known to all. He was forged in an environment that gave him “relentless conditions to develop a critical spirit and the confidence to ignore dogmas and shift paradigms.” These virtues are the hallmarks of his professional life both as a clinician and a professor. His greatest legacy undoubtedly lies in the latter, I mean his contribution to the academic universe. He is one of a handful of teachers who helped transition Brazilian orthodontics from a mere echoer of knowledge to a position of worldwide leadership. All this he accomplished without losing sight of the premise that patients “are my primary goal.”

I mentioned above our intuition because it helps us realize the benefits that orthodontics brings to the population. And cleft patients provide us with an obvious touchstone to measure the extent of these benefits. Moreover, the article by Feu and colleagues on indicators of quality of life and their importance in orthodontics further enhances this understanding. By describing and illustrating various dentistry-related indicators of quality of life the authors managed to conveniently sum up the knowledge available on the different ways in which our specialty can impact on people’s lives. And the number of people who need orthodontic treatment is huge. To gain an insight into what I mean by that, just read the article by Machado Bittencourt, who evaluated 4776 Brazilian children during the campaign “Prevention is Easier to Handle,” conducted in 18 Brazilian states by the Brazilian Association of Orthodontics and Dentofacial Orthopedics.

Finally, the broad scope of orthodontics can be experienced in a simple and direct manner by observing the figure generated with the words used in this issue of the Journal (Fig 1). The size of each word represents how frequently they appear in the articles. It is remarkable to note the myriad effects that orthodontic treatment can produce in patients.

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What´s new in Dentistry

Moving teeth faster, better and painless. Is it possible?

José A. Bósio, Dawei Liu

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The history has shown attempts to correct crowded or protruding teeth since 3000 year ago. Egyptian mummies have been found with crude metal bands wrapped around individual teeth, and primitive and surprisingly well-designed orthodontic appliances have also been found with Greek and Etruscan artifacts.1 From Pierre Fauchard, passing through Ben Kingsley, Calvin Case, and finally to Edward H. Angle, we have seen technology evolved. The modern era of orthodontics has initiated its history around 1900 and has gone from metal bands adjusted around the teeth to bonded braces on the buccal and the lingual sides, as well as clear aligners, mini-implants/ mini-plates, self-ligating brackets, digital models, lasers and so on. Thus, the continuing quest for improvements on materials and techniques leads us to the desire to treat patients faster, better, and totally painless. Today, many people receive orthodontic treatment which brings about better occlusion, improved oral function and harmonized facial appearance. However, two perplexing challenges have not been solved in clinical orthodontics, i.e. long treatment time (on average 2-3 years) and iatrogenic root resorption. Figuring out these challenges will dramatically improve the quality of orthodontic care.


Orthodontic Insight

Orthodontic forced eruption: Possible effects on maxillary canines and adjacent teeth

Alberto Consolaro, Renata Bianco Consolaro, Leda A. Francischone

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Canine forced eruption comprises one among a number of procedures that can be used in orthodontic treatment to ensure that cuspids are positioned in the dental arch in normal esthetic and functional conditions. Canine forced eruption should be characterized as an orthodontic movement.

Unfortunately, in discussions of clinical orthodontic practice some professionals are reluctant to indicate orthodontic forced eruption, especially of maxillary canines. These professionals believe that orthodontic forced eruption can cause many clinical problems during and after surgery. Among the most widely cited reasons for restricting the indication of orthodontic forced eruption are:

1) Lateral root resorption in lateral incisors and premolars.

2) External cervical resorption of canines due to forced eruption.

3) Dentoalveolar ankylosis of the canine involved in the process.

4) Calcific metamorphosis of the pulp and aseptic pulp necrosis.

In two previous works, we reviewed the first two topics. In this last article in the series we address the biological foundation of dentoalveolar ankylosis, replacement resorption, calcific metamorphosis of the pulp and aseptic necrosis cases either directly or indirectly related to the orthodontic forced eruption of canines.


An interview with Leopoldino Capelozza Filho

Adilson Luiz Ramos

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• Dentistry Graduate, Bauru School of Dentistry, São Paulo University (1972).

• M.Sc. in Orthodontics, Bauru School of Dentistry, São Paulo University (1976).

• Ph.D. in Oral Rehabilitation, Area of Periodontics, Bauru School of Dentistry, São Paulo University (1979).

• Began his professional career as founder and head of the Orthodontics Department, aka “Centrinho” (Rehabilitation Hospital of Craniofacial Anomalies, Sao Paulo University (HRAC-USP).

• Faculty member of the postgraduate department, (HRAC-USP).

• In the early 80’s, started his private orthodontic practice gaining extensive experience in the orthodontic treatment of children and adults with dental and/or skeletal deformities, and dental follow-up.

• Former Assistant Professor and Ph.D., São Paulo University; Professor, Postgraduate (Masters) Program in Orofacial Clefts (HRAC-USP); Visiting Professor, Julio de Mesquita Filho Sao Paulo State University, Orthodontist, HRAC-USP, Advisor to the Foundation for Research Support, Sao Paulo. With many publications in national and international journals, and significant participation in orthodontic conferences, currently coordinates the Specialization Program in Orthodontics (Profis) encompassing the Specialization and Masters Programs in Orthodontics, Sacred Heart University (USC), and collaborates with several graduate courses in orthodontics.

Online Article

Orthodontics as risk factor for temporomandibular disorders: a systematic review

Eduardo Machado, Patricia Machado, Paulo Afonso Cunali, Renésio Armindo Grehs

emporomandibular joint dysfunction syndrome. Temporomandibular joint disorders. Craniomandibular disorders. Temporomandibular joint. Orthodontics. Dental occlusion.

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Introduction: The interrelationship between Orthodontics and Temporomandibular Disorders (TMD) has attracted an increasing interest in Dentistry in the last years, becoming subject of discussion and controversy. In a recent past, occlusion was considered the main etiological factor of TMD and orthodontic treatment a primary therapeutical measure for a physiological reestablishment of the stomatognathic system. Thus, the role of Orthodontics in the prevention, development and treatment of TMD started to be investigated. With the accomplishment of scientific studies with more rigorous and precise methodology, the relationship between orthodontic treatment and TMD could be evaluated and questioned in a context based on scientific evidences.

Objective: This study, through a systematic literature review had the purpose of analyzing the interrelationship between Orthodontics and TMD, verifying if the orthodontic treatment is a contributing factor for TMD development.

Methods: Survey in research bases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs and BBO, between the years of 1966 and 2009, with focus in randomized clinical trials, longitudinal prospective nonrandomized studies, systematic reviews and meta-analysis.

Results: After application of the inclusion criteria 18 articles was used, 12 of which were longitudinal prospective nonrandomized studies, four systematic reviews, one randomized clinical trial and one meta-analysis, which evaluated the relationship between orthodontic treatment and TMD.

Conclusions: According to the literature, the data concludes that orthodontic treatment cannot be considered a contributing factor for the development of Temporomandibular Disorders.

Evaluation of level of satisfaction in orthodontic patients considering professional performance

Claudia Beleski Carneiro, Ricardo Moresca, Nicolau Eros Petrelli

Patient satisfaction. Orthodontics. Professional-patient relationship.

Objective: Considering the increasing professional concern in conquering new patients and maintaining them satisfied with treatment, this study aimed to evaluate the level of satisfaction of patients in orthodontic treatment, considering the orthodontist s performance.

Methods: Sixty questionnaires were filled out by patients in orthodontic treatment with specialists in Orthodontics, from Curitiba. The patients were divided into two groups. Group I consisted of 30 patients which considered themselves unsatisfied and changed orthodontists in the last 12 months. Group II consisted of 30 patients which considered themselves satisfied, and were in treatment with the same professional for at least, 12 months.

Results and Conclusion: after statistical analysis, using the chi-square test, it was concluded that the factors statistically associated to patient’s level of satisfaction considering the orthodontist´s performance were: professional degree, professional referral, motivation, technical classification, doctor-patient personal relationship and interaction. For orthodontic treatment evaluation, the factors that determined statistical differences for patients’ level of satisfaction were: the number of simultaneously attended patients and the integration of the patients during the appointments.

Bone density assessment for mini-implants position

Marlon Sampaio Borges, José Nelson Mucha

Bone density. Orthodontic anchorage procedures. Orthodontics.

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Introduction: Cortical thickness, interradicular space width and bone density are key factors in the use of mini-implants as anchorage. This study assessed maxillary and mandibular alveolar and basal bone density in Hounsfield units (HU).

Methods: Eleven files with CT images of adults were used to obtain 660 measurements of bone density: alveolar (buccal and lingual cortical) bone, cancellous bone and basal bone (maxilla and mandible). The Mimics software 10.0 (Materialise, Belgium) was used to estimate values.

Results: In the maxilla, the density of buccal cortical bone in the alveolar region ranged from 438 to 948 HU, and the lingual, from 680 to 950 HU; cancellous bone ranged from 207 to 488 HU. The buccal basal bone ranged from 672 to 1380 HU, and cancellous bone, from 186 to 402 HU. In the mandible, the buccal cortical bone ranged from 782 to 1610 HU, the lingual cortical alveolar bone, from 610 to 1301 HU, and the cancellous bone, from 224 to 538 HU. In the basal area, density was 1145 to 1363 HU in the buccal cortical bone and 184 to 485 HU in the cancellous bone.

Conclusions: In the maxilla, the greatest bone density was found between the premolars in the buccal cortical bone of the alveolar region. The maxillary tuberosity was the region with the lowest bone density. Bone density in the mandible was higher than in the maxilla, and there was a progressive increase from anterior to posterior and from alveolar to basal bone.

Quality of life instruments and their role in orthodontics

Daniela Feu, Cátia Cardoso Abdo Quintão, José Augusto Mendes Miguel

Quality of Life. Orthodontics. Malocclusions.

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Objective: The purpose of this study was to survey reliable information about quality of life as it relates to oral health in the literature, allowing clinicians to access and understand its influence on the process of finding and treating their patients. 

Methods: The MEDLINE, LILACS, BBO and Cochrane Controlled Trials electronic databases were researched between 1980 and 2010 and 158 studies were found that discuss quality of life related to oral health. 

Results: Thirty studies were selected: two prospective longitudinal studies, two systematic reviews, five casecontrol studies, twelve epidemiological studies, five cross-sectional studies and three reviews of literature, in addition to the Statement of the World Health Organization (WHO). The selection was based on the goal of describing the indicators of quality of life and the methodology used in the studies. 

Conclusions: The use of quality of life indicators in dental research and clinical orthodontics are extremely important and helpful in diagnosis and planning but do not replace standard indexes and should be used in a strictly complementary manner.

Evaluation of the effect of rapid maxillary expansion on the respiratory pattern using active anterior rhinomanometry: Case report and description of the technique

Edmilsson Pedro Jorge, Luiz Gonzaga Gandini Junior, Ary dos Santos-Pinto, Odilon Guariza Filho, Anibal Benedito Batista Arrais Torres de Castro

Pyogenic granuloma. Gingival hyperplasia. Periodontal diseases. Orthodontics. Gingiva.

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The aim of the present investigation is to evalute the effect of rapid maxillary expansion

(RME) on the respiratory pattern. A clinical case is presented to describe how

patients with atresic maxilla and respiratory problems can benefit from rapid maxillary

expansion. The article highlights that the health professional, mainly the Orthodontist

and the Otorhinolaryngologist, may use complementary exams to diagnose a mouth

breather patient.

Non-neoplastic proliferative gingival processes in patients undergoing orthodontic treatment

Mirian Aiko Nakane Matsumoto, Fábio Lourenço Romano, José Tarcísio Lima Ferreira, Silvia Tanaka, Elizabeth Norie Morizono

Pyogenic granuloma. Gingival hyperplasia. Periodontal diseases. Orthodontics. Gingiva.

Introduction: Orthodontic appliances render oral hygiene difficult and may contribute to the development of gingival lesions such as non-neoplastic proliferative gingival processes. These lesions, depending on such factors as development time, histopathological components and oral conditions may be reversible in some cases, through oral hygiene advice and basic periodontal therapy. In most cases, however, surgical treatment is required.>

Objectives: The purpose of this paper is to report the case of a patient using fixed orthodontic appliance who presented with two distinct gingival lesions diagnosed as pyogenic granuloma and inflammatory gingival hyperplasia. The clinical and histopathological features, incidence and frequency, treatment modalities and prevention of both lesions were discussed, highlighting the importance of submitting the material collected from the lesions to histopathological examination given the possibility of different diagnostic hypotheses. Surgical excision was performed on both lesions. The upper arch lesion, diagnosed as pyogenic granuloma, relapsed, which led us to provide basic periodontal therapy and repeat the surgical procedures.

  Results: The lesion in the lower arch, diagnosed as gingival hyperplasia, was surgically removed and followed up clinically, whereas the patient was instructed to perform proper oral hygiene.

BBO Case Report

Angle Class III malocclusion, subdivision right, treated without extractions and with growth control*

Sérgio Henrique Casarim Fernandes

Angle Class III. Maxillary protraction. Interceptive orthodontics.

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Angle Class III malocclusion is characterized by anteroposterior dental and facial discrepancies usually accompanied by skeletal changes associated with a genetic component. Early, accurate diagnosis and appropriate treatment are of paramount importance to promote growth control and prevent relapse. This article reports the two-phase treatment of a female patient, aged 12 years, with an Angle Class III, subdivision right malocclusion with anterior crossbite in maximum intercuspation (MIC) and end-on bite in centric relation, further presenting with lack of maxillary space. The case was treated without extractions and with growth control. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) as representative of Category 1, i.e., Angle Class III malocclusion treated without tooth extractions, as part of the requirements for obtaining the BBO Diploma.

Special Article

Lower incisor extraction: An orthodontic treatment option

Mirian Aiko Nakane Matsumoto, Fábio Lourenço Romano, José Tarcísio Lima Ferreira, Silvia Tanaka, Elizabeth Norie Morizono

Orthodontics. Corrective Orthodontics. Tooth extraction.

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Lower incisor extraction can be regarded as a valuable option in the pursuit of excellence in orthodontic results in terms of function, aesthetics and stability. The aim of this study was to gather information about the indications, contraindications, advantages, disadvantages and stability of the results achieved in treatments performed with lower incisor extraction. This treatment option may be indicated in malocclusions with anterior tooth size discrepancy due to narrow maxillary incisors and/or large mandibular incisors. It is contraindicated in malocclusions without anterior discrepancy or with discrepancies caused by large maxillary incisors and/or narrow mandibular incisors. The literature suggests this method affords improved posttreatment stability compared with premolar extraction. As well as a careful diagnosis, established with the aid of a diagnostic setup, professional skills and clinical experience are instrumental in achieving successful orthodontic results with this treatment option.
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