Dental Press Jounal of Orthodontics
Dental Press International

v. 16, no. 2

Dental Press Journal of Orthodontics – ISSN 2176-9451

Dental Press J. Orthod.

v. 16, no. 2

March / April



In 2015, Brazil will become the main knowledge producer in dentistry in the world

Jorge Faber

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Economic analysts, World Bank staff and academics in this area agree that Brazil will assume the position of the fifth largest economy in the world in a relatively short time. Those into science may even be surprised by economic growth, but not with the way of investigating and projecting the country?s position. Regression statistical models, which in the research area language is synonymous with ?forecast?, are used for this purpose. The historical series are analyzed and future scenarios are estimated. 

In fact, this is a recurring tool in different studies published in the pages of DPJO. In science, in some cases it is crucial to analyze data to develop predictive models. These models are used as parameters to predict outcomes, to classify cases and understand the difficulty of certain treatments. 

The statistics are also used to evaluate the quantity and quality of scientific production of countries and specialties. One of the databases available for consultation to this end is the SCOPUS1, and, recently I did an analysis of the information provided by it. This exercise included evaluating descriptive statistics of scientific production from major country producers of knowledge in dentistry. I evaluated two aspects: the production of all areas and orthodontics alone. 

In 1996, the first year in this database, Brazil was in 17th place in ranking of number of articles produced in dentistry. However, when we evaluate the total production between 1996 and 2009, Brazil jumped to fourth place. The year of 2009 is the last with a SCOPUS list. However, the most interesting is what happens when we detail this research a little more. If only the year 2009 is submitted for consideration, our country is in second place in number of produced articles, being only behind of the USA. 

When evaluating the specialty of orthodontics in isolation, the data are even more motivating. Throughout all the period of 1996-2009, our country is in second place in the ranking of publications in the area. But when only the years 2008 and 2009 are analyzed, we are?shocker?1st in the number of articles, and a factor H higher than the U.S. (the H factor measures the amount weighted by the quality of work and that is being measured by the number of citations). 

The fact of being the first country in the world in publications on orthodontics is not everything. The data matrix does not incorporate the Dental Press Journal of Orthodontics published in English. It means that our number of citations will increase exponentially in the near future. The journal, published with the name ?Revista Dental Press de Ortodontia e Ortopedia Facial?, had a rapid growth in recent years, as can be witnessed at the SCOPUS site. In certain configurations of search, our journal is in 3rd place in the international arena. But this is just the beginning. 

Impressed with the growth of Brazilian publication in dentistry, I was puzzled over the future scene. Maintaining current growth rates of the publishing countries how will we be in 5 years? To understand the future scenario, I searched the number of articles published by the major nations over a decade, and performed linear regression models?read ?prediction??to foresee their ranking in 2016. Figure 1 includes all the countries reviewed and have, in the yellow area, the future. Brazil will become in 2015 the main producer of knowledge in dentistry in the world, overtaking the USA. Note our rising curve. 

The change of scientific polarity will have a strong impact in our country. Our schools will have to adapt to receive foreign students speaking English. Do not be dismayed. Americans and Europeans will become regulars in our universities, reversing the migration route established in the twentieth century. Such cooperation will be very beneficial for everyone. 

Course coordinators in Brazil, get ready for this scenario. You will get these students and play often the role of leading international research groups.

What´s new in Dentistry

Digital technologies and CAD/CAM systems applied to lingual orthodontics: The future is already a reality

Carla Maria Melleiro Gimenez

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Lingual orthodontics has been gaining space around the world due to its particularity to offer a discreet treatment option, ?invisible?, in ?secret? for the correction of malocclusion, combining biomechanical efficiency and enhancement of the smile during treatment. 

As the brackets are on the lingual surface, the point of force application is closer to the center of resistance, maximizing the potential of induced tooth movement, which results in faster clinical achievements and significant control over the mechanics. 

A landmark study was published in 2001,by Dr. Scuzzo and Dr. Takemoto,9 which gave new perspective to lingual orthodontics describing the possibility of permanently eliminating compensating bends, with a Straight-Wire system, based on differential bracket positioning, placed more to the cervical region of the tooth. Within this context, the PSWb6 (Prieto Straight-Wire brackets), a Brazilian bracket that is now in its third generation, was developed based on three principles: more cervical bonding (base without gingival extension beyond the slot, higher gingival wing far from the gums), anterior bracket profile slightly increased (compensation for the Straight- Wire technique can be possible); distal offset in the canine bracket, the second premolar bracket with its profile slightly higher than the first premolar bracket. It is important to mention that this bracket enables the simplified indirect bonding technique as a routine in orthodontics practice, facilitating bonding, mechanics during treatment and finishing (Fig 1). [...]

Orthodontic Insight

Tooth whitening products in toothpastes and mouthwashes may act as co-carcinogens in the oral mucosa

Alberto Consolaro, Leda A. Francischone, Renata Bianco Consolaro

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At the conclusion of clinical orthodontic treatments, patients very often ask about the need or possibility of tooth whitening. During treatment, patients sometimes ask about the use of toothpastes or mouthwashes with whitening products. In several situations, they may ask direct questions, such as:

? Is bleaching good or bad for my health?

? Does it cause cancer?

? Are you in favor or against it?

We discuss tooth whitening in this article as a way to help orthodontists to define indications and establish guidelines for their patients. Since the old Egyptian civilization, human beings have expressed their desire to have bright, white teeth.12,41 According to historical references,22 the pioneering external tooth whitening procedure should be assigned to Atkinson, who, in 1893, described the use of a 3% hydrogen peroxide solution as a mouthwash for children to reduce caries and whiten their teeth. He found that at a 5% concentration, whitening was greater, and much greater when concentration was 25%, but the risk of lesions to soft tissues increased substantially due to the caustic effect of the whitening product. Tooth whitening has been described in the scientific literature since the beginning of modern times.6,15,20,48  [...]


An interview with Jason Cope

Marcos Alan Vieira Bittencourt

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? Graduated in Biology, Southern Methodist University, Dallas, Texas.

? Graduated in Dentistry, Baylor College of Dentistry, Dallas, Texas.

? Graduated in Orthodontics, Baylor College of Dentistry, Dallas, Texas.

? Graduated in Craniofacial Biology, TAMUS ? Baylor College of Dentistry, Dallas,


? Diplomate, American Board of Orthodontists.

? Full Member, Edward H. Angle Society of Orthodontists, Southwest Component.

? Fellow, American College of Dentists.

? Adjunct Clinical Assistant Professor, Department of Orthodontics, TAMUSHSC

? Baylor College of Dentistry, Dallas, Texas - 1997 to 2009.

? Adjunct Assistant Professor, Department of Oral & Maxillofacial Surgery and Pharmacology,

TAMUSHSC ? Baylor College of Dentistry, Dallas, Texas - 2005 to 2009.

? Adjunct Associate Professor, Department of Graduate Orthodontics, St. Louis

University, St. Louis, Missouri.

? Editor, OrthoTADs: The Clinical Guide and Atlas, 2007 Under Dog Media, LP,

? Editor,

Online Article

Influence of inter-root septum width on mini-implant stability

Mariana Pracucio Gigliotti, Guilherme Janson , Sérgio Estelita Cavalcante Barros, Kelly Chiqueto, Marcos Roberto de Freitas

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Objective: The purpose of this study was to evaluate the influence of the inter-radicular septum width in the insertion site of self-drilling mini-implants on the stability degree of these anchorage devices. 

Methods: The sample consisted of 40 mini-implants inserted in the inter-radicular septum between maxillary second premolars and first molars in 21 patients to provide skeletal anchorage for anterior retraction. The post-surgical radiographs were used to measure the septum width in the insertion site (ISW). In this regard, the mini-implants were divided in two groups: group 1 (critical areas, ISW?3 mm) and group 2 (non-critical areas, ISW>3 mm). The degree of mobility (DM) was monthly quantified to determine mini-implant stability, and the success rate of these devices was calculated. This study also evaluated the sensitivity degree during miniscrew load, amount of plaque around the miniscrew, insertion height, and total evaluation period. 

Results: The results showed no significant difference in mobility degree and success rate between groups 1 and 2. The total success rate found was 90% and no variable was associated with the miniscrew failure. Nevertheless, the results showed that greater patient sensitivity degree was associated to the mini-implant mobility and the failure of these anchorage devices happened in a short time after their insertion. 

conclusion: Septum width in the insertion site did not influence the self-drilling miniimplant stability evaluated in this study.

Demystifying self-ligating brackets

Renata Sathler, Renata Gonçalves Silva, Guilherme Janson , Nuria Cabral Castello Branco, Marcelo Zanda

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Currently self-ligating brackets have been associated to faster and more efficient treatments, which arouse the curiosity to compare them to the conventional system. Unlike traditional appliances, self-ligating brackets do not require elastomeric or metal ligatures. The literature is abundant in concluding that this feature decreases, ostensibly, the friction resistance during sliding mechanics. Moreover, there are reports on minimizing the need of extractions and maxillary expansion using these accessories. Therefore, the purpose of this literature review was to seek the newest studies about self-ligating brackets currently used in orthodontic treatments, confirming or correcting current speculations.

Original Article

Use of orthodontic records in human identification*

Rhonan Ferreira da Silva, Patrícia Chaves , Luiz Renato Paranhos, Marcos Augusto Lenza, Eduardo Daruge Júnior

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Objective: This study describes a forensic case of incinerated remains that were identified using information found in his orthodontic records. 

Method: Incinerated remains of a man were found inside a car. After forensic crime scene investigation and postmortem and radiographic exams in the Forensic Department, forensic experts found that the victim had a fixed orthodontic appliance, supernumerary teeth in all quadrants, partially erupted third molars and amalgam restorations in some surfaces of several teeth. As the individual?s soft tissues were substantially destroyed, identification using fingerprints was not the ideal choice. After orthodontic records were handed in by the family, his clinical chart, radiographs, intra- and extraoral photographs and impressions were analyzed, and these data were compared with previously collected information. 

Results and conclusions: Forensic dentistry examination revealed 20 concordant points in specimen examination and orthodontic records, which enabled the establishment of a positive correlation between the cadaver under examination and the missing person and eliminated the need for further analyses (DNA tests) to identify the victim.

Sleep bruxism: Therapeutic possibilities based in evidences

Eduardo Machado, Patricia Machado, Paulo Afonso Cunali, Cibele Dal-Fabbro

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Introduction: Sleep bruxism (SB) is defined as a stereotyped and periodic movement disorder, characterized by tooth grinding and/or clenching occurring during sleep, associated with rhythmic masticatory muscle activity. This condition isn?t a disease, but when exacerbated may cause an unbalance and changing of orofacial structures. Thus, it is necessary to obtain effective and safe treatments for the control and management of the bruxist patient. The treatment alternatives range from oral devices, pharmacological therapies to cognitive-behavioral techniques. 

Objective: This study, a systematic literature review having as research bases MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs and BBO, between the years of 1990 and 2008, with focus in randomized and quasi-randomized clinical trials, systematic reviews and meta-analysis, had as objective to analyze and discuss possibilities of treatment for sleep bruxism. 

Results: According to the literature analysis there is a lot of treatment options for the SB, but many of the therapies have no scientific support. Thus, the choice therapy should be based on scientific evidences and in clinical common sense, for an improvement in quality of life of the bruxist patient.

Longitudinal evaluation of dental arches individualized by the WALA ridge method

Márcia de Fátima Conti, Mário Vedovello Filho, Silvia Amélia Scudeler Vedovello, Heloísa Cristina Valdrighi, Mayury Kuramae

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Introduction: The mandibular arch form is considered one of the main references among the diagnostic tools because the maintenance of this arch form and dimension is an important factor for stability of orthodontic treatment. 

Objectives: to evaluate the changes in mandibular intercanine and intermolar widths during orthodontic treatment and 3 years of post treatment, in which the WALA ridge was used for individualization of the mandibular arch form. 

Methods: The sample comprised 20 patients (12 women and 8 men), with a mean age of 20.88 years. The dental casts of the initial, final and post-treatment evaluations were used for measurement of the intercanine and intermolar distances in the center of the facial surface of the clinical crown and in the width of the WALA ridge. Data were analyzed by means of ANOVA test followed by Tukey test (p<0.05). 

Results: There was a statistically significant difference in intercanine and intermolar distances among the three stages evaluated. These distances increased significantly with treatment, and presented a reduction in the post-treatment period, however not reaching the initial values. 

conclusions: the WALA ridge method used in this study for construction of the individualized diagrams and for measurement of the intercanine and intermolar distances was shown to be valuable, allowing the individualization of the dental arches and favoring the post-treatment stability.

Electronic cephalometric diagnosis: Contextualized cephalometric variables

Marinho Del Santo Jr., Luciano Del Santo

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Introduction: Classical parametric assessments and isolated cephalometric variables may not provide the best information in craniofacial morphology. Rather, contextualized cephalometrics can be more promising, since it allows for integration among weighty cephalometric variables. 

Objective: The main purpose of this manuscript is to present the application of a non-trivial mathematical model in cephalometrics, providing data mining by filtering certainty and contradiction in each network ?node?. 

Methods: In the proposed ?neural network?, each ?cell? is connected to others ?cells? by ?synapses?. Such decision-making system is an artificial intelligence tool tailored to potentially increase the meaning of assessed data. 

Results: The comparison between the final diagnosis provided by the paraconsistent neural network with the opinions of three examiners was heterogeneous. Kappa agreement was fair for anteroposterior discrepancies, substantial or fair for vertical discrepancies and moderate for dental discrepancies. For the bimaxillary dental protrusion, the agreement was almost perfect. Similarly, the agreement among the three examiners, without any software aid, was just moderate for skeletal and dental discrepancies. An exception was dental protrusion, which agreement was almost perfect. 

conclusions: In conclusion, the analysis of performance of the developed technology supports that the presented electronic tool might match human decisions in the most of the events. As an expected limitation, such mathematical-computational tool was less effective for skeletal discrepancies than for dental discrepancies.

Comparative study of facial proportions between Afro-Brazilian and white Brazilian children from 8 to 10 years of age*

Cassio Rocha Sobreira, Gisele Naback Lemes Vilani, Vânia Célia Vieira de Siqueira

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Objective: To evaluate the vertical facial proportions of Afro-Brazilian and white Brazilian female children, aged 8-10 year-old, and to evaluate differences between the race groups. 

Methods: The authors evaluated 70 cephalometric radiographs, in lateral norm, equally divided into the two groups, 22 at 8-year-old, 18 at 9-year-old, and 30 at 10-year-old. All the patients showed harmonious facial esthetics, normal occlusion and none of them were subjected to previous orthodontic treatment. The following proportions were evaluated: LAFH/TAFH (ANS-Me/N-Me), TPFH/TAFH (S-Go/N-Me), LPFHTPFH (Ar-Go/S-Go), LPFH/LAFH (Ar-Go/ANS-Me). Data were analyzed by descriptive statistics and Student?s t-test in order to compare the differences between the race groups, ANOVA with Bonferroni?s test for comparison between the ages and Pearson?s correlation coefficient to examine the level of association between facial proportions. Statistical analysis was performed at the 0.05 level of significance. 

Results: The findings showed no statistically significant differences between the groups and between the ages for each group, for all variables. 

conclusion: There were no significant differences in facial proportions between Afro-Brazilian and white Brazilian female children. The facial proportions remained constant from 8 to 10 years of age, regardless the racial group.

Evaluation of the shear bond strength of two composites bonded to conditioned surface with self-etching primer

Matheus Melo Pithon, Rogério Lacerda dos Santos, Márlio Vinícius de Oliveira, Eduardo Franzotti Sant’Anna , Antônio Carlos de Oliveira Ruellas

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Aim: The aim of this study was to evaluate the shear bond strength and the Adhesive Remnant Index (ARI) between the composites Eagle Bond and Orthobond bonded to an enamel surface conditioned with Transbond Plus Self-Etching Primer. 

Methods: Seventy-five bovine permanent mandibular incisors, divided into five groups (n=15) were used. In Groups 1, 2 and 4, the bonds were performed with Transbond XT, Orthobond and Eagle Bond respectively, in accordance with the manufacturers? recommendations. In Groups 3 and 4, before bonding with Orthobond and Eagle Bond, respectively, the tooth surface was conditioned with the acid primer Transbond Plus Self-Etching Primer. After bonding the shear test was performed of all samples at a speed of 0.5 mm per minute in an Instron mechanical test machine. 

Results: The results (MPa) showed that there were no statistically significant differences among Groups 1, 2, 3 and 5 (p>0.05). However, these groups were statistically superior to Group 4 (p<0.05). The ARI (Adhesive Remnant Index) results showed a higher number of fractures at the bracket/composite interface in Groups 1, 2, 3 and 5.

Chemical and morphological analysis of the human dental enamel treated with argon laser during orthodontic bonding

Glaucio Serra Guimarães, Liliane Siqueira de Morais, Carlos Nelson Elias , Carlos André de Castro Pérez, Ana Maria Bolognese

Argon laser. Tooth enamel. Orthodontic bonding.

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Introduction: The main utilities of the argon laser in orthodontics are the high speed curing process in orthodontic bonding and the caries resistance promotion of the tooth enamel. 

Objective: To evaluate the chemical and morphological changes in the tooth enamel treated with the argon laser in the orthodontic bonding parameters. 

Methods: Fifteen sound human first premolars, removed for orthodontic reason, were selected and sectioned across the long axis in two equal segments. One section of each tooth was treated and the other remained untreated. A total of thirty samples was analyzed, creating the laser (n =15) and the control groups (n =15). The treatment was done with 250 mW argon laser beam for 5 seconds, with energy density of 8 J/cm2. 

Results: The X-ray analysis demonstrated two different phases in both groups, the apatite and the monetite phases. The reduction of the monetite phase was significant following laser treatment, suggesting higher crystallinity. The EDS analysis showed an increase in the calcium-phosphorus ratio in the laser group, linked with the decrease of the monetite phase. The surface morphology was smoother after the laser exposure. 

conclusion: The results of high crystallinity and superficial enamel smoothness in the laser group are suggestive of the caries resistance increase of the tooth enamel.

Epidemiology of long face pattern in schoolchildren attending middle schools at the city of Bauru - SP

Maurício Almeida Cardoso, Leopoldino Capelozza Filho, Tien Li An, José Roberto Pereira Lauris

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Objective: This study aimed to classify and determine the prevalence of individuals with vertical alteration of facial relationships, according to the severity of discrepancy, especially individuals with long face pattern. 

Methods: The sample was composed of 5,020 individuals of Brazilian nationality, of both genders, aged 10 years to 16 years and 11 months, attending middle schools at the city of Bauru-SP, Brazil. Examination of facial morphology comprised direct observation of the face in frontal and lateral views, always with the lip at rest, aiming to identify individuals presenting vertical alteration of facial relationships. After identification, these individuals were scored, according to severity, into three subtypes, namely mild, moderate and severe. The prevalence of individuals with long face pattern considered only the individuals scored as subtypes moderate and severe. 

Results: There was prevalence of 34.94% of vertical alteration of facial relationships and 14.06% of long face pattern. 

conclusions: The results obtained in this study revealed that the prevalence of vertical alteration of facial relationships and long face pattern was higher than that reported in the literature.

BBO Case Report

Angle Class II malocclusion treated without extractions and with growth control

Maria Tereza Scardua

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Angle Class II malocclusion is defined according to the anteroposterior molar relationship with or without a discrepancy between basal bones. Maxillary protrusion and  mandibular retrusion are included in this pattern. When orthodontic treatment starts  at an early age, it is possible to affect growth of both basal bones and the dentoalveolar  region, which helps to correct tooth positioning in the corrective phase. This report  describes the treatment of a case of Angle Class II, division 1 malocclusion that was presented to the Committee of the Brazilian Board of Orthodontics and Facial Orthopedics  (BBO) as partial fulfillment of the requirements to obtain the BBO Diploma. The case  was representative of category 1, that is, Angle Class II malocclusion treated without  extractions and with growth control.

Special Article

Checklist of esthetic features to consider in diagnosing and treating excessive gingival display (gummy smile)

Máyra Reis Seixas , Roberto Amarante Costa-Pinto , Telma Martins de Araújo

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Introduction: Excessive gingival display on smiling is one of the problems that negatively affect smile esthetics and is, in most cases, related to several etiologic factors that act in concert. A systematic evaluation of some aspects of the smile and the position of the lips at rest can facilitate the correct assessment of these patients. 

Objective: To present a checklist of dentolabial features and illustrate how the use of this record-keeping method during orthodontic diagnosis can help decision making in treating the gummy smile, which usually requires knowledge of orthodontics and other medical and dental specialties.

Dental Press Journal of Orthodontics - v. 16, no. 2 Download full issue pdf