Dental Press Jounal of Orthodontics
Dental Press International

v. 17, no. 2

Dental Press Journal of Orthodontics – ISSN 2176-9451

Dental Press J. Orthod.

v. 17, no. 2

March / April



Optimizing time and space

David Normando

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In my first editorial,1 I made a brief analysis of the construction of the Dental Press Journal of Orthodontics (DPJO). In contrast to the poetic and emotional vein of that first text,1 fruit of the profound gratitude to those that appointed me captain of this ship, I will use this opportunity to describe, to our readers and other collaborators (publishers, authors and reviewers), some of the adjustments to be made in this journal. These changes begin in this issue and will be completed in the next (17.3), or maybe will never cease, depending on sea winds and our disquiet. The role of the editor is to chart the course of the journal and to steer the helm so that the prow is kept in the direction of the route defined by our predecessors.

The main scope of such effort was to reduce the navigating time between manuscript submission and effective publication, as stated at the end of that previous editorial.1 The high incoming of manuscripts is the main reason why DPJO takes a mean of three years to complete the whole process. Our objective is to reach, by the end of 2012, a maximum time of eighteen months and reduce it further until we manage to navigate this route in six to twelve months. Unfortunately, to achieve these goals, some ?not so sympathetic? measures should be taken.

The acceptance rate for manuscripts submitted in 2009 was 60%; it went down to 50% in 2010, and corresponded to only 1/3 (34%) of all submissions in 2011 (Fig 1). Although no rigid goal has been defined, the level of rejection of manuscripts submitted in 2012 is expected to be close to 75%.

The second measure is to increase the number of manuscripts published in each issue of the journal. For that, the number of studies published online will increase, a measure that has started to be delineated in 2010. The perspective for this year is to publish six online articles for each issue. The new layout of the journal, starting with the current number, will also favor the inclusion of four more manuscripts in each journal issue. These measures, in association with the reduction of articles size, now limited to 3500 words, will lead to more objective manuscripts in which the main information receives intense focus. Therefore, our readers will have more information in each issue and authors will enjoy the pleasure of seeing their production sailing away into the world sooner. Submissions will also be adjusted. We are conducting a minor restructuring of the board of reviewers to increase the number of foreign collaborators and to meet the requirements of international indexing databases. Moreover, the Dental Press Journal of Orthodontics will soon accept only submissions in English. The purpose of this decision is to make it easier to prepare the journal layout. However, the print version in Portuguese will continue being delivered to all subscribers; for now, only the English version will remain available online via SciELO.

For a mature journal, the changes suggested actually amount to almost nothing in light of such a well conceived and consolidated enterprise. Only a few changes at the helm to prioritize the movement to where the prow is directed. Modest adjustments to make our cartography more precise and to optimize time and space so that we achieve the aim of consolidating the ?necessity? so acclaimed by Pompey and that have been part of our lives since before Christ.

Enjoy your reading!


An interview with Ki Beom Kim

Luiz Gonzaga Gandini Junior, Marcelo de Castellucci e Barbosa, Orlando Motohiro Tanaka, Paulo Vicente Rocha

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- Associate Professor and Clinical Director of the Department of Orthodontics, New Southeastern University, Fort Lauderdale (Florida), United States.

- Adjunct Professor, Department of Orthodontics, Saint Louis University, United States, from 2005 to 2011.

- Graduated in the American Board of Orthodontics, 2011.

- Residency in Orthodontics at Vanderbilt University (Nashville), United States, 2005.

- Doctor of Orofacial Pain by Dankook University, South Korea, 2002.

- Graduated in the American Board of Orofacial Pain, 2000.

- Master in Dentistry by Dankook University, South Korea, 1995.

- Residency in Oral Medicine and Temporomandibular Disorders by Dankook University, South Korea, 1995.

It is a great honor and I am glad to bring to the readers a little bit of the scientific experience and knowledge from one of the most important current researchers and clinician in the United States: Prof. Dr. Ki Beom Kim. We have confirmed that Prof. Kim dedicated a profound attention when answering the questions from the interviewers, proving respect for us, the readers of the Dental Press Journal of Orthodontics. During this interview, he discussed with a lot of property important current matters and of great relevance, such as the use of 3D image technologies, self-ligating brackets, mini-implants and orthodontic treatment on patients with temporomandibular disorder. A deep lover and fond of sports and photography, Prof. Kim, despite working with state of the art means available in Orthodontics, he believes in diagnostic and in strict and individual planning as the main way to reach success in orthodontic treatments. Married and father of 2 sons, Prof. Kim was born in South Korea and there he graduated in Dentistry and post-graduated in Orofacial pain. After this, he moved to the United States and never left. Nowadays, he is an Associated Professor and Clinical Director on the Department of Orthodontics at the New Southeastern University (Fort Lauderdale, Florida/United States), where he is the Clinical Director of the Post-Graduation Program. I hope you all enjoy this opportunity of knowing some of his point of view and the way this great researcher and clinician works. 

Marcelo Castellucci

Orthodontics Highlights

Induced tooth movement: Standardization of terms to describe the effects of forces on the periodontal ligament Compression/Traction instead of Pressure/Tension

Alberto Consolaro

Tooth movement. Orthodontic movement. Pressure. Tension. Traction. Compression.

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There is no reason for Dentistry to use different terms for phenomena defined in Physics, the specific field in which concepts associated with forces are established and adapted. In place of pressure/tension, the compression/traction pair should be used. This study defines each one of these terms and justifies their use. Our contemporary world demands standardized criteria, methods, measures, concepts and terms to ensure that study protocols, results and applications are used in the same way in any country or area of human action.

Online Article

Influence of saliva contamination on the shear bond strength of adhesives on enamel

Tatiana Feres Assad-Loss, Mônica Tostes, José Nelson Mucha

Objective: To evaluate shear bond strength of 3 adhesive systems (Single Bond, Transbond? MIP and Transbond ? XT) applied on bovine enamel under saliva contamination condition. 

Methods: One hundred and twenty enamel surfaces of bovine incisors were divided into 6 groups (n = 20) according to the adhesive system used (Transbond? XT, Transbond? MIP and Single Bond) with or without saliva contamination. For each adhesive system, there were two groups defined as no contamination group (NC): 37% H3PO4 conditioning for 30 seconds and two layers of adhesive systems; saliva contamination group (SC): After the first adhesive layer application, the examined areas were contaminated with saliva. Samples were mounted appropriately for testing and stored in deionized water at 37 °C for 7 days. Samples were then submitted to shear bond strength trials at a speed of 0.5 mm/min. The Adhesive Remnant Index (ARI) was evaluated under stereomicroscopy. Twoway analysis of variance and the Tukey test were used to compare mean values (? = 0.05). Results: Groups XT (NC) = 26.29 ± 7.23; MIP (NC) = 24.47 ± 7.52 and SB (NC) = 32.36 ± 4.14 XT (SC) = 19.59 ± 6.76; MIP (SC) = 18.08 ± 6.39 and SB (SC) = 18.18 ± 7.03 MPa. ARI 0 and 1 were the most prevalent scores in all study groups examined. 

Conclusion: Saliva contamination significantly decreased bond strength of the three adhesive systems examined (p <0.05). However, the comparison of groups with and without saliva contamination did not reveal any significant differences, and, therefore, the three systems may be considered equivalent.

Effectiveness of CO2 laser in removal of papillary gingival hyperplasia

Sabrina Kívia Correia Gama, Fernando Antônio Lima Habib, Mauren Bitencourt Deprá, Telma Martins de Araújo

Laser. Gingival hyperplasia. Orthodontics.

Introduction: Laser applications have increased in a variety of dental procedures, especially in surgeries of soft tissues. Radiation is not invasive and is very well tolarated by tissues. CO2 laser acts in small vessels promoting blood coagulation, making it possible to work in a controlled way. Patients undergoing fixed orthodontic therapy often present injuries of gingival hyperplasia, originating esthetical and functional problems. 

Objective: This study aimed at evaluating the CO2 laser effectiveness in removal of hyperplasia lesions in gingival papilla regions of patients with fixed orthodontic appliances. For this, ten patients were chosen and in these 75 teeth with gingival hyperplasia were identified. Measures from the papilla to incisal edge were performed with the use of a digital caliper. Besides that, the individuals were submitted to previous examinations to the surgical procedure with laser: Full blood count, blood coagulation profile and fasting blood glucose. After this, patients were submitted to the surgery for lesion removal, carried out at the Laser Center of FOUFBA, utilizing a CO2 laser machine (Sharplan 20C, Tel Aviv, Israel). 

Results: It was showed that laser provided a significant increase (p<0,001) in the distance from the papilla to the incisal edge of the teeth, with no tissue contraction, aspects which were maintained for over two months. Conclusion: It can be concluded that CO2 laser has proved to be effective in removal of papillary gingival hyperplasia lesions.

Orthodontic retainers: Analysis of prescriptions sent to laboratories

Washington Komatsu Assumpção, George Kenji Bezerra Ota, Rívea Inês Ferreira , Flávio Augusto Cotrim-Ferreira

Orthodontics. Corrective. Orthodontic appliances. Relapse

Objective: To investigate the most commonly fabricated orthodontic retainers. 

Methods: Information on the type and amount of maxillary and mandibular retainers produced in a three-month period was collected from six laboratories (in the cities of São Paulo, Mauá and Guarulhos). The retainers were grouped according to the total production. For the maxillary arch, the groups were: 1S ? Begg retainer, 2S ? Hawley retainer, 3S ? transpalatal arch retainer, 4S ? buccal resin-arch retainer, and 5S ? vacuum-formed retainer, Planas appliance, bonded lingual retainer and V-loop bonded lingual retainer. The groups relative to the mandibular arch were: 1I ? 3-3 bonded lingual retainer (canine-to-canine), 2I ? Hawley retainer and V-loop bonded lingual retainer, 3I ? Begg retainer, 4I ? buccal resin-arch retainer, vacuum-formed retainer and Planas appliance. The data were presented in box plots. Groups were compared using the Student?s t-test with Bonferroni correction. 

Results: The average of maxillary appliances fabricated ranged from 189.5 (1S) to 3.95 (5S). There were significant differences between groups 1S versus 5S and 2S versus 5S (p < 0.0001). Mean values for the mandibular retainers ranged from 55.3 (1I) to 4.2 (4I). Significant difference was observed between groups 2I and 4I (p < 0.0001). 

Conclusions: For the maxillary arch, the most requested retainers were Begg and Hawley retainers. Regarding the mandibular arch, bonded lingual retainers and Hawley retainer were the most frequent ones.

Risk variables of external apical root resorption during orthodontic treatment

Orthodontics. Root resorption. Tooth movement.

Introduction: External apical root resorption (EARR) is an adverse outcome of the orthodontic treatment. So far, no single or associated factor has been identified as responsible for EARR due to tooth movement. 

Objective: This study investigated the association of risk variables (age, gender, extraction for orthodontic treatment and Angle classification) with EARR and orthodontic treatment. 

Methods: The sample (n=72) was divided into two groups according to presence (n=32) or absence (n=40) of EARR in maxillary central and lateral incisors after orthodontic treatment. Results: There were no statistically significant differences in EARR according to age, gender, extraction or type of malocclusion (p>0.05). 

Conclusion: The risk variables examined were not associated with EARR in the study population.

Cone-Beam computed tomography evaluation of maxillary expansion in twins with cleft lip and palate

Palatal expansion. Midpalatal fissure. Cone-Beam computed tomography. Orthodontics.

Introduction: The establishment of normal occlusal relationships in patients with cleft lip and palate using rapid maxillary expansion may promote good conditions for future rehabilitation. 

Objective: This study describes the clinical case of monozygotic twins with unilateral cleft lip and palate at the age of mixed dentition who were treated using the same rapid maxillary expansion protocol, but with two different screws (conventional and fan-type expansion screw). Results were evaluated using plaster models, intraoral and extraoral photographs, and Cone-Beam Computed Tomography (CBCT) scans obtained before the beginning of the treatment, (T1). 

Methods: The patients were followed up for 6 months after maxillary expansion, when the same tests requested at T1 were obtained again for review (T2). T1 and T2 results were compared using lateral cephalometric tracings and measurements of the intercanine and intermolar distances in the plaster models using a digital caliper. Results: The two types of expansion screws corrected the transverse discrepancy in patients with cleft lip and palate. The shape of the upper arches improved at 10 days after activation. 

Conclusion: CBCT scans provide detailed information about craniofacial, maxillary and mandibular changes resulting from rapid maxillary expansion. The most adequate screw for each type of malocclusion should be chosen after detailed examination of the dental arches.

Dentofacial characteristics of patients with Angle Class I and Class II malocclusions

Rogério Lacerda dos Santos, Antônio Carlos de Oliveira Ruellas

Malocclusion. Cephalometry. Angle?s classification.

Objective: The present study assessed some cephalometric measurements of the soft tissue profile in order to observe the behavior of facial convexity in patients with Class I, Class II division 1, and Class II division 2 malocclusions. 

Methods: One hundred and thirty pre-treatment cephalometric radiographs of Caucasian patients aged 10-16 years (mean age of 12.6 years) were selected for study and divided into 3 groups. The cephalometric measurements used in the present study were the following: H.SN, Cx, NLA, MLA, UL-SUL-S, LL-S, IMPA, and 1-SN. Analysis of variance and Tukey?s test were applied for measurements H.SN, Cx, IMPA, 1-SN, MLA, and NLA, whereas Kruskal- Wallis and Dunn?s tests were applied for UL-S and LL-S. 

Results: The results showed statistically significant differences for the measurements H.SN, Cx, UL-S, and IMPA between Groups I, II-1 and II-2 (p < 0.05). Measurements LL-S and MLA showed statistically significant difference between Groups I and II-1 only (p < 0.05). On the other hand, no statistically significant differences were found for measurement NLA among the 3 groups (p < 0.05). 

Conclusion: Regarding facial characteristics expressed by measurements H.SN, Cx, and UL-S, one could conclude that Class II division 1 and Class II division 2 malocclusions, both differed from Class I malocclusion. In addition, Class II division 1 malocclusion was found to have facial characteristics expressed by MLA, which differentiate it from the Class II division 2 and Class 1 malocclusions. Class I, Class II division 1 and Class II division 2 malocclusions showed no difference in facial characteristics expressed by the measurement NLA, and measurement LL-S was directly related to eversion of the lower lip.

Original Article

Early cephalometric characteristics in Class III malocclusion

Vanessa Costa Farias, Ricardo de Souza Tesch, Odilon Vitor Porto Denardin, Weber José da Silva Ursi

Angle Class III malocclusion. Cervical maturity. Cephalometry.

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Objective: Early identification of craniofacial morphological characteristics allows orthopedic segmented interventions to attenuate dentoskeletal discrepancies, which may be partially disguised by natural dental compensation. To investigate the morphological characteristics of Brazilian children with Class III malocclusion, in stages I and II of cervical vertebrae maturation and compare them with the characteristics of Class I control patients.  Methods: Pre-orthodontic treatment records of 20 patients with Class III malocclusion and 20 control Class I patients, matched by the same skeletal maturity index and sex, were selected. The craniofacial structures and their relationships were divided into different categories for analysis. Angular and linear measures were adopted from the analyses previously described by Downs, Jarabak, Jacobson and McNamara. The differences found between the groups of Class III patients and Class I control group, both subdivided according to the stage of cervical vertebrae maturation (I or II), were assessed by analysis of variance (ANOVA), complemented by Bonferroni?s multiple mean comparisons test. 

Results: The analysis of variance showed statistically significant differences in the different studied groups, between the mean values found for some angular (SNA, SNB, ANB) and linear variables (Co ? Gn, N ? Perp Pog, Go ? Me, Wits, S ? Go, Ar ? Go). 

Conclusion: Assessed children displaying Class III malocclusion show normal anterior base of skull and maxilla, and anterior positioning of the mandible partially related to increased posterior facial height with consequent mandibular counterclockwise rotation.

Immunosuppressants: Implications in Orthodontics

Rogério Lacerda dos Santos, Maria Cláudia Mesquita Lacerda, Renato Torres Gonçalves, Marco Aurélio Martins, Margareth Maria Gomes de Souza

Immunosuppressant. Tooth movement. Bone.

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Introduction: There are medications capable of affecting bone metabolism and the rate of tooth movement.  Among these medications are the immunosuppressants, which act by repressing the action of T lymphocytes, however they can cause bone loss and consequently lead to osteoporosis. Osteoporosis is a common complication following kidney, heart, liver or lung transplantation. The immunosuppressant treatment for preventing organ rejection after transplantation, in general, includes glucocorticoids, cyclosporine, tacrolimus, and sirolimus. All these  drugs can have jeopardizing effects on bone mineral homeostasis and consequently influence tooth movement. In  recent years, however, the increasing use of immunosuppressants has raised questions about their effects on bone  metabolism in patients undergoing orthodontic treatment.  

Objective: The objective of this review study was to inform orthodontists about the influence of immunosuppressants on bone metabolism and tooth movement.

General dentist orthodontic practice in foreign legal systems

Ivan Toshio Maruo, Armando Saga, Maria da Glória Colucci, Orlando Motohiro Tanaka, Hiroshi Maruo

Orthodontics. Graduation course. General dentist. Legality. Foreign laws

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Objective: General dentist orthodontic practice is a controversial issue and this paper aims to analyze it comparing foreign laws to Brazilian Legal System.  

Methods: Regulations and scientific texts concerning orthodontic practice by general dentists, in Portuguese or  English language, were sought.  

Results and Conclusion: Portugal clearly forbids general dentist orthodontic practice; United States of America  do not clearly forbid general dentist orthodontic practice, but do regulate and promote campaigns to encourage  public to seek specialist service; in Australia and England, corrective orthodontics are offered both by orthodontists and general dentists; it was not possible to evaluate how orthodontic services are provided in Eastern Europe;  and the fact that general dentists are forbidden to practice corrective orthodontics in Brazilian Legal System is  compatible to other countries policy.

Rebonding of unused brackets with different orthodontic adhesives

Emígdio Enrique Orellana Jimenez, Sérgio Paulo Hilgenberg , Marcia Cristina Rastelli, Gibson Luiz Pilatti, Bruno Orellana, Ulisses Coelho

Shear bond strength. Brackets. Orthodontic adhesives. Rebonding

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Objective: To compare in vitro shear bond strength (SBS) of different orthodontic adhesives in bonding and repeatedly rebonding metal brackets, and to evaluate the bond failure site with the adhesive remnant index (ARI). 

Methods: Specimens consisted of 90 extracted human first premolars, randomly divided into three groups  (n=30). The adhesives Alpha Plast (AP), Concise? (CO) and Transbond? XT (TB) were used in each group.  Three SBS tests were performed, i.e., one at T0  (initial) and the other two at T1  and T2  (first and second rebondings, respectively), observing a 24-hour interval. The tests were performed in a Shimadzu AG-I (10kN) SBS testing machine, at a speed of 0.5 mm/min. 

Results: SBS data were subjected to ANOVA, Tukey?s test and Bonferroni test (p<0.05). For the ARI, the Kruskal Wallis test was performed, followed by the Dunn test. The results revealed that at T0  groups AP and CO showed SBS values  that were near, but above TB values; and at T1  and T2 , the highest SBS values were observed for the AP group, followed  by the CO and TB groups.  

Conclusion: Statistically significant differences were found in SBS between groups AP, CO and TB during bonding  and repeated rebondings of unused metal brackets, with group AP achieving the highest SBS value. Regarding ARI,  adhesive AP exhibited bond failure at the enamel-adhesive interface, with a higher enamel fracture frequency.

Influence of anatomical barriers on maxillary incisor root resorption after orthodontic treatment with premolar extractions

Antonio Geraldo de Oliveira, Fabiana Guilhermina Ferreira Castro

Anatomical barriers. Root resorption. Maxillary incisors. Orthodontic treatment.

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Intoduction: Apical root resorption is a frequent and occasionally critical problem in orthodontic patients undergoing induced tooth movement. One of the factors that might influence prognosis, especially in maxillary incisors,  which most frequently present resorptions, are the so-called the anatomical barriers; that is, proximity of the buccal  and palatal cortical bones to the maxillary incisor roots.  

Objective: The purpose of this research was to investigate whether patients with excessive vertical growth really  present a small distance between the alveolar cortical bones and the maxillary incisor roots, and whether there is a  correlation between this distance and the root resorption index in comparison with patients presenting horizontal  growth.  

Methods: The sample comprised orthodontic records of 18 patients with extraction planning of first maxillary premolars and treatment by the standard and/or preadjusted edgewise brackets. Their initial and final periapical radiographs were evaluated to determine the amount of root resorption that occurred.  

Results: On the palatal side, patients with excessive vertical growth (Group 2 - SN-GoGn ? 43º) showed a narrower  alveolar bone than the horizontal growth patients (Group 1 - SN-GoGn ? 29º). However, the distance between the  buccal cortical bone and the central incisor root apex showed no significant difference between Groups 1 and 2;  

Conclusions: It was concluded that there are no correlations between the proximity of buccal cortical bone, maxillary incisor roots and the root resorption index.

Temporomandibular disorders and parafunctional oral habits: An anamnestic study

Melissa de Oliveira Melchior, Marcelo Oliveira Mazzetto, Cláudia Maria de Felício

Temporomandibular Joint disorders. Signs and symptoms. Habits.

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Objective: To assess the frequency and severity of the signs and symptoms of temporomandibular disorders  (TMD), the frequency of parafunctional oral habits and the correlation between the variables by means of the patients? perception regarding their problem. 

Methods: One hundred patients diagnosed with TMD, through a clinical examination of their masticatory system,  answered the questions of a previously published protocol concerning the signs and symptoms most frequently  reported in the literature. 

Results: According to the results from the non parametric statistical analysis, the frequency for the following signs  and symptoms was significant: Fatigue and muscle pain, joint sounds, tinnitus, ear fullness, headache, chewing  impairment and difficulty to yawn (p<0.01) and otalgia (p<.05). As to the parafunctional oral habits, there was a  significant presence of teeth clenching during the day and night (p<0.01) and teeth grinding at night (p<0.05). The  variable correlation analysis showed that there was a positive correlation between symptom frequency and severity; age was correlated with the presence of otalgia, cervical pain and teeth sensitivity, besides being correlated  with muscle and joint pain severity. Habit frequency was negatively correlated with age. TMD duration was also  positively correlated with the symptoms of tinnitus, ear fullness, muscle and joint pain. 

Conclusion: The study results showed that the anamnestic assessment using ProDTMMulti can predict the severity of the TMD case.

Treatment of snoring and sleep apnea syndrome with a removable mandibular advancement device in patients without TMD

Eduardo Rollo Duarte, Maria Luiza M. A. Frigério, Orivaldo Tavano, Paulo César Razuk, Maria Rita de Cássia M. Costa, Carlos Henrique Ferreira Martins, Maurício Serejo Ribeiro, Éderson A. G. Betiol

Snoring. Obstructive sleep apnea. Mandibular advancement. Occlusal splints.

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Introduction: Among the sleep disorders reported by the American Academy of Sleep, the most common is obstructive  sleep apnea-hypopnea syndrome (OSAHS), which is caused by difficulties in air passage and complete interruption of air  flow in the airway. This syndrome is associated with increased morbidity and mortality in apneic individuals.  Objective: It was the objective of this paper to evaluate a removable mandibular advancement device as it provides  a noninvasive, straightforward treatment readily accepted by patients.  

Methods: In this study, 15 patients without temporomandibular disorders (TMD) and with excessive daytime  sleepiness or snoring were evaluated. Data were collected by means of: Polysomnography before and after placement of an intraoral appliance, analysis of TMD signs and symptoms using a patient history questionnaire, muscle  and TMJ palpation.  

Results: After treatment, the statistical analysis (t-test, and the ?before and after? test) showed a mean reduction of  77.6% (p=0.001) in the apnea-hypopnea index, an increase in lowest oxyhemoglobin saturation (p=0.05), decrease in  desaturation (p=0.05), decrease in micro-awakenings or EEG arousals (p=0.05) and highly significant improvement  in daytime sleepiness (p=0.005), measured by the Epworth Sleepiness Scale. No TMD appeared during the monitoring period.  

Conclusion: The oral device developed in this study was considered effective for mild to moderate OSAHS.

Is orthodontic treatment a risk factor for temporomandibular disorders?

Antonio Sérgio Guimarães, Tomas Magnusson

Temporomandibular disorder. Occlusion. Orthodontic treatment.

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Introduction: The possibility that orthodontic treatment in childhood might be a risk factor for the development  of temporomandibular disorders (TMD) later in life has been an issue of great controversy in dental literature.  

Objective: To determine a possible negative or positive correlation between orthodontic treatment and TMD by  presenting the results and conclusions from a number of key-papers dealing with this subject.  

Results and Conclusion: According to current knowledge, there is no scientific evidence to support that orthodontic treatment is a risk factor for the development of TMD. On the other hand, there is some evidence to support that a proper orthodontic treatment performed in childhood might have a positive effect upon the functional  status of the masticatory system later in life.

Influence of palatoplasty on occlusion of patients with isolated cleft palate

Omar Gabriel da Silva Filho, Elisa Teixeira Marinho, Rita de Cássia Moura Carvalho Lauris

Dental arch. Cleft palate. Dental occlusion.

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Objective: This study compared the dental arch morphology of adult patients with isolated cleft palate in order to  verify the influence of palatoplasty on occlusion.  

Methods: Cast models of 77 patients, 30 males and 47 females, with an average age of 21 years and no syndromes were  taken. They were in the permanent dentition and had not undergone orthodontic treatment. The sample was divided  into non-operated and operated patients, the latter having been submitted to palatoplasty at a mean age of 2.2 years.  

Results: Almost 80% of the sample exhibited sagittal discrepancies in the inter-arch relationship, with a Class II malocclusion prevailing (59.74%) followed by Class III (20,78%), regardless of palatoplasty. Transverse analysis showed  a 23% incidence of posterior crossbite also not influenced by palatoplasty. Intra-arch relationship indicated that constriction and crowding on the upper arch were more frequent in the operated group (p=0.0238 and p=0.0002, respectively), showing an influence of palatoplasty on its morphology. The predominant morphological characteristics in  patients with isolated cleft palate were a Class II malocclusion, upper dental arch constriction and upper and lower  anterior crowding. 

Conclusion: The influence of palatoplasty was restricted to constriction and crowding of the upper dental arch, with  no interference from the extension of the cleft, except for the upper crowding, which occurred more in patients with  complete cleft palates

Evaluation of dry needling and 0.5% lidocaine injection therapies in myofascial pain trigger points in masticatory muscles

Renato Oliveira Ferreira da Silva, Paulo César Rodrigues Conti, Carlos dos Reis Pereira Araújo, Rafael dos Santos Silva

Myofascial pain. Trigger point. Needling therapies.

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Objective: The purpose of this study was to compare the effectiveness of trigger points injections using lidocaine  0.5% and dry needling without any kind of home-based rehabilitation program.  

Methods: Sixteen patients with myofascial pain and trigger points in masticatory muscles were randomly assigned  to two groups and received only one application session. The pressure pain threshold (PPT) was recorded before  and after the injection: Ten minutes, 24 hours later, 7, 15, 21 and 30 days after the treatment. Visual analogue scale  (VAS) was used to in all evaluation periods.  

Results: There were no difference between groups for PPT, but for all groups the PPT during the time significantly increased when compared the before treatment. VAS showed differences between groups and during the time. The 0.5% lidocaine had the lowest VAS values when compared to dry needling, but at 30 days there were no differences among them.  

Conclusion: Despite the differences in VAS and considering there were no differences in PPT increases, we concluded that, in this study, both groups were able to disrupt the mechanisms of trigger point and relieve the myofascial pain symptoms.

Prevalence of non-nutritive sucking habits and its relation with anterior open bite in children seen in the Odontopediatric Clinic of the University of Pernambuco

Luiza do Nascimento Cezar Magalhães, Maria José Rodrigues, Mônica Vilela Heimer, André Suliano de Alencar

Habits. Open bite. Suction. Prevalence.

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Objective: The aim of this work was to establish the prevalence of non-nutritive sucking habits (pacifier and/or  digit sucking) and to assess its relation with anterior open bite. 

Methods: The sample consisted of 980 records of children of both genders, with ages between 3 and 12 years, who  were treated at the Pediatrics Clinic of the University of Pernambuco (FOP/UPE), from February 2000 trough December 2005, both sexes. Pearson?s Chi-square test at 5% level of significance was used for statistical assessment. 

Results: It was observed that 17,7% of the sample had some habit at the moment of the anamnesis (9,6% of digit  sucking habit, 8,8% of pacifier sucking habit and 0,7% of both habits) and that the prevalence of open bite was  20,3%. The prevalence of sucking habits in girls was much higher than in boys (22,6% and 12,9%, respectively)  and this difference was statistically significant (p = 0,000). A correlation between habits and open bite was proved  statistically (p = 0,000): Children with sucking habits had 8 times more chances of developing anterior open bite. 

Conclusions: Anterior open bite was associated to the presence of non nutritive sucking habits; sucking habits  were more prevalent in girls and in children between three and six years of age.

Photometric study of divine proportion and its correlation with facial attractiveness

Ana Paula Lazzari Marques Peron, Imara Castro Morosini, Keila Rodrigues Correia, Ricardo César Moresca, Nicolau Eros Petrelli

Divine proportion. Facial analysis. Golden section. Facial esthetic.

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Objective: The aim of this study was to evaluate if there is correlation between perception of facial esthetic and  divine proportion, verifying if most attractive faces are closer to and less attractive faces are more distant to this  proportion. 

Methods: Standard facial photographs (frontal and lateral) in natural head position were taken of a sample of 85  Brazilian Caucasian women, with mean age of 23 years and 9 months. The photographs were evaluated by 5 orthodontists, 5 artists and 5 laymen and were classified, according to their subjective analysis of facial esthetic, in  pleasant, acceptable and not pleasant. Frontal photographs were evaluated by divine proportion analysis using the  computerized method. 

Results and Conclusions: According to subjective analysis the sample consisted 18.8% of pleasant, 70.6% of acceptable and 10.6% of not pleasant faces. After statistical analysis, a lack of agreement was verified in esthetic facial  preferences among the three groups of observers. It was also possible to verify that in this research there was no  correlation between perception of facial beauty and divine proportion.

Aspects and clinical procedures of eruptive changes of permanent upper canines

Sheila Marcia Francisco, Mario Cappellette Junior

Impacted upper canines. Etiology. Tooth impaction.

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Introduction: Even though the upper canine is the tooth that presents most eruption anomalies, after the third molars, canine retention prevalence in the population is quite low. Local, physiologic and pathologic factors can provide difficulties for the tooth eruptive process. The correct diagnosis in trying to prevent upper canine retention with ectopic eruption is fundamental to choose the ideal treatment, which can be performed by various methods.

Objective: The present paper has the purpose of approaching aspects related to impacted upper permanent canines by a literature review, including localization and treatment conducts.

Cephalometric evaluation of skeletal alterations induced by Herbst appliance during mixed dentition

Luana Paz Sampaio Dib, Dirceu Barnabé Raveli , Ary dos Santos-Pinto, Denise Rocha Goes Landázuri, Savana de Alencar Maia

Herbst appliance. Class II malocclusion. Early treatment

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Objective: The present prospective clinical study was designed in order to evaluate horizontal and vertical skeletal alterations induced by the use of Herbst appliance in individuals with Class II, division 1 malocclusion during  mixed dentition stage.  

Methods: The sampling consisted of 15 pre-pubertal individuals (12 boys and 3 girls; initial age 9 years and 6  months), who were treated with Herbst appliance for a period of 7 months. The effects of the treatment were compared to a group of 15 individuals with Class II, division 1 malocclusion (8 boys and 7 girls, initial age averaged 9  years and 1 month), orthodontically untreated, who were followed up for a period of 12 months. Statistical analysis  was performed with Student?s t-test with significance level at 5%.  

Results: It was showed that the treatment with Herbst appliance in mixed dentition stage has restricted maxilla  growth. Mandibular and palatal planes have not undergone significant alteration; however, anterior and posterior facial heights have increased significantly. Facial convexity and maxillomandibular relationship were altered  positively. Mandible has positioned significantly forward and its effective length increased 2.5 times more than the  increase observed in control group.  

Conclusion: It was possible to conclude that Herbst appliance was able to provide satisfactory results in individuals during mixed dentition stage. 

Asymmetric extractions in orthodontics

Camilo Aquino Melgaço , Mônica Tirre de Souza Araújo

Asymmetric extraction. Mechanics. Treatment. Orthodontics.

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Introduction: Extraction decisions are extremely important in during treatment planning. In addition to the extraction decision orthodontists have to choose what tooth should be extracted for the best solution of the problem  and the esthetic/functional benefit of the patient. 

Objective: This article aims at reviewing the literature relating the advantages, disadvantages and clinical implications of asymmetric extractions to orthodontics.  

Methods: Keywords were selected in English and Portuguese and the EndNote 9 program was used for data base  search in PubMed, Web of Science (WSc) and LILACS. The selected articles were case reports, original articles and  prospective or retrospective case-control studies concerning asymmetrical extractions of permanent teeth for the  treatment of malocclusions.  

Conclusion: According to the literature reviewed asymmetric extractions can make some specific treatment mechanics easier. Cases finished with first permanent molars in Class II or III relationship in one or both sides seem  not to cause esthetic or functional problems. However, diagnosis knowledge and mechanics control are essential  for treatment success.

Calcium, amylase, glucose, total protein concentrations, flow rate, pH and buffering capacity of saliva in patients undergoing orthodontic treatment with fixed appliances

Hellen Soares Teixeira, Stella Maris Oliveira Kaulfuss, Jucienne Salgado Ribeiro , Betina do Rosário Pereira, João Armando Brancher, Elisa Souza Camargo

Saliva. Corrective orthodontics. Demineralization.

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Objective: To evaluate qualitative and quantitative changes in the saliva of individuals undergoing orthodontic  treatment with fixed appliances.  

Methods: Salivary samples were collected from 50 individuals divided in two groups: Experimental Group ? patients with fixed orthodontic appliances (n=25); and Control Group ? subjects with no orthodontic appliances  (n=25). Salivary flow rate, pH, buffering capacity, amylase activity, concentrations of total proteins, calcium and  glucose were measured in all salivary samples.  

Results: There was a reduction in salivary pH and buffering capacity and an increase in the concentration of calcium ions in the experimental group (p<0.05); there was also an increase in glucose, amylase and protein concentrations in the saliva of the Experimental Group, but the differences were insignificant. There was insignificant  correlation between calcium ion concentration and salivary flow or between buffering capacity and salivary flow.  

Conclusion: The saliva of individuals with fixed orthodontic appliances had lower pH, buffering capacity and calcium concentration than that of individuals without any type of orthodontic appliance. These oral changes are  enough to cause tooth demineralization. Patients with orthodontic appliances should adopt additional oral hygiene procedures. 

BBO Case Report

Skeletal and dental Class II malocclusion, with anterior open bite and accentuated overjet

Márlio Vinícius de Oliveira

Angle?s Class II malocclusion. Open bite. Tooth extraction.

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Open bite is defined as a deficiency in normal vertical contact between antagonist teeth and may manifest in a limited  region, or more rarely throughout the entire dental arch. If the lack of contact between teeth is located in the incisor  and/or canine region when occlusion is in centric relation, it is called anterior open bite (AOB). Some studies have  demonstrated that AOB is strongly associated with non-nutritional sucking habit. This article relates the treatment  of a female African-Brazilian patient, with 20 years and 7 months of age, who presented Angle?s Class II, division  1 malocclusion, AOB, accentuated overjet, lingual interposition during swallowing and difficulty with pronouncing  some phonemes. Orthodontic treatment began by mounting an Edgewise Standard fixed appliance system, with a  fixed palatal crib appliance and extraction of maxillary first premolars. This case was presented to the Brazilian Board  of Orthodontics and Facial Orthopedics (BBO), as part of the requisites to become a BBO Diplomate.

Special Editorial

The role of friction in orthodontics

Mariana Ribeiro Pacheco, Wellington Correa Jansen, Dauro Douglas Oliveira

Orthodontics. Orthodontic brackets. Dental materials

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Introduction: Sliding mechanics is widely used during orthodontic treatment. One of the disadvantages of this  mechanics is the friction generated at the bracket/archwire interface, which may reduce the amount of desired  orthodontic movement obtained. Due to the application and great acceptance of this type of mechanics, the role  of friction in Orthodontics has been of interest for both clinicians and scientists.  

Objective: Therefore, this article discussed how friction affects orthodontic tooth movement, with an approach to its  clinical implications as well as the evolution of dental materials and its properties regarding resistance to sliding. 

Dental Press Journal of Orthodontics - v. 17, no. 2 Download full issue pdf