Dental Press Jounal of Orthodontics
Dental Press International

v. 18, no. 2

Dental Press Journal of Orthodontics – ISSN 2176-9451

Dental Press J. Orthod.

v. 18, no. 2

March / April



The clinician and the scientific evidence

David Normando

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No, our science is no illusion. But an illusion it would be to suppose that what science cannot give us we can get elsewhere (Sigmund Freud).

It is noticed a detachment between the shape of published researches and the language used among clinicians. It is no wonder clinicians prefer case reports instead of papers plenty of methodologies and awkward terminologies. The language and imagery of clinical cases are rooted in the daily practice and have the aura of objectivity, for this reason they are assimilated. On the other hand the scientific rigor is blurred by the methodology, what makes it boring. "Narcissus finds ugly what isn't his mirror", says a Brazilian composition.

The Science demands the systematization of methods to which clinicians are not bonded or used to. Nevertheless, many even were not introduced to these methods and neither had any contact with the design of scientific studies during undergraduation, this way it becomes an uneasy, thorny and limping script. Without a basis change only a few will get interest on the evidence-based dental practice while on the top of their professional career. The university is the cradle of the graduation and it has little by little bowed to the necessity of reducing such a distance. For us the right path is to correct this asymmetry and to bring undergraduates closer to the research. It is believed that only this way the future professionals will be able to understand the reasons for giving even more attention for a systematic review than to a clinical case. The issue is how to establish its importance if one does not even know what is a systematic review and its modus operandi?

Recently Prof. Flores-Mir --- head of Department of Orthodontics of the University of Alberta, in Canada and also recently interviewed in this Journal --- has told that his students since the beginning of the graduation start learning step by step the construction of a systematic review. This publication method is extremely interesting and important for the process of continuous education of clinicians. But, how is it possible to read if we don't understand the process for constructing an article? How to appreciate if when we start reading, the text looks written is Javanese and conjugated in the harder verbal tense, and the methods also look more important than the results? I'm convinced that we need to change the format of scientific publications. This disruption aims at giving lower value to the method, pushing it to the end of the manuscript.

Even in science, changes occur slowly and have to be peer reviewed, that's why they retard to change. However I can see in the Brazilian orthodontics interesting attitudes aiming at the question core. I have been invited to explain in courses of continuing education about the process of formation of the scientific knowledge and the reason of greater trust in some kind of studies and researches. The main objective of these meetings is to provide clinicians the magnificent information that will bring them bigger chance of success in the next clinical case. In May next there will be an event promoted by the 'Associação Paranaense de Ortodontia' (Orthodontic Association of Paraná State, Brazil) focusing to orientate clinicians concerning the importance of scientific evidence for daily practice: A commendable challenge headed by Prof. Alexandre Moro. Also Dental Press in its course of excellence in orthodontics has been doing similar process. It is worth of taking a look.

As participant of the process of developing Brazilian orthodontic science, in combination with the need of bring clinicians a better understanding of the development of scientific research, the Dental Press Journal of Orthodontics will initiate in the second half of 2013 a selection of short papers dealing with the many face of orthodontic science applied to the clinic. This section will be coordinated by the associate-editor Prof. Dr. Fernanda Angelieri. Various researches will be invited to try to make narrower the language between the scientific orthodontics and the orthodontic clinic. The idea is to render the scientific methodology to something more pleasing, trying to raise the logic of the Austrian philosopher Wittgenstein, breaking the glass shards over the walls of language to break through the frontiers of the universe.

Orthodontics Highlights

Matheus Melo Pithon

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With computerization of the contemporary world, access to information has become rapid and practical. Following this trend, this has benefited the biomedical field, because nowadays clinicians do not need to wait for a scientific meeting to keep up-to-date. However, with the great amount of scientific information available, what can really be taken into consideration and brought to the daily clinic? With the intention of solving these questions and attempting to separate "the wheat from the chaff", systematic reviews appear with the goal of "fishing" in an "ocean" of information for the most reliable answer to a certain question. In line with this trend and in seeking answers there is an old, but ever up to date topic: Rapid maxillary expansion. Italian researchers assessed whether this procedure would induce side effects in growing individuals. After an extensive search of the literature, they arrived to the conclusion that rapid maxillary expansion does not cause injuries in growing individuals. However, the authors open a parenthesis and emphasize that as a result of the low quality of studies found and available, no scientifically based conclusion could be drawn, leaving the suggestion of conducting future researches with greater methodological strictness.

Orthodontic Insight

Effects of medications and laser on induced tooth movement and associated root resorption: Four key points

Alberto Consolaro

Induced tooth movement. Root resorption. Tooth resorption. Laser therapy. Medication.

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The following four fundamental points on the use of experimental models will be described to ensure an accurate evaluation of the effects of medication and laser therapy on induced tooth movement and associated root resorption: (1) If the objective is to check the effect on root resorption, the forces experimentally applied must produce a lesion on the cementoblast layer in all specimens; (2) If the objective is to optimize induced tooth movement and reduce treatment time without side effects, the forces experimentally applied should not produce a lesion in the cementoblast layer in any specimen; (3) The laser therapy operator, the person administering medication and the person that places appliances should not know which animals will effectively receive the test treatment, and the control groups should receive placebo treatments; (4) CT and microscopic analysis of the specimens should be random, and the group to which the specimen belongs should not be identified to ensure that the person reading images and the pathologists are not influenced in their evaluation of phenomena. These measures will ensure that results are more reliable and easier to extrapolate to orthodontic clinical practice.


An interview with Ajalmar Maia

Cátia Cardoso Abdo Quintão, Marco Rosa, Guilherme Janson , Leopoldino Capelozza Filho

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»Graduated in Dentistry, Federal University of Rio Grande do Norte - UFRN (1976), Brazil.

»MSc, Pediatric Dentistry, University of São Paulo - USP (1978), Brazil. 

»PhD (1993) and Post-doctorate (2007), Pediatric Dentistry, USP, Brazil. 

»Associate Professor, UFRN, Brazil.



It is a pleasure to talk about the life of a winning man. Brazil is rich in stories as the one that I am about to tell in this interview, but poor in acknowledging their value. Ajalmar Maia was born in Umarizal, a small town in the interior of the state of Rio Grande do Norte, Brazil. One of the sons of a large family of humble origins, quite common in the middle of the last century, he started working at an early age as a sales assistant and spent his teenage years in several jobs, which I am not going to describe to avoid losing focus on his greatest virtue: his tenacious quest for knowledge. Even when working very hard, Ajalmar never left school. At the age of 17, he joined the Brazilian Air Force, his second mother in his own words. While in the Air Force, he entered the School of Dentistry of the Federal University of Rio Grande do Norte (UFRN), Brazil. His intelligence, not equaled by many, associated with immeasurable strength to work and determination to learn eventually led him to unequaled success in his profession. Dr. Ajalmar Maia specialized in Orthodontics in the School of Dentistry of Lins and got his Master's Degree in the School of Dentistry of Bauru (FOB), University of São Paulo (USP). He returned to Natal, already a professor at UFRN, and met his wife and fellow dentist, Nair, mother of his three children (Najwa, Nayara and Ajalmar), working companion and life partner. After that, he obtained his doctorate also at FOB/USP. A model of success in private clinic not matched by any I have ever seen in Brazil, he also has time to write several books, from poetry to Dentistry, and dozens of scientific articles. After all that, he returned to Bauru for a post-doctorate program, mentored by Professor Guilherme Janson, one of the interviewers in this section. Professor Ajalmar is more than it all together: writer, poet, professor, airplane pilot, composer that won several music festivals in the region where he lives, and a great fan of Brazilian popular culture. Ajalmar is a rich fruit of the Brazilian Agreste region, who did not give in to the scorching sun and that used education to grow as an example of success in our profession. 

David Normando
Editor in Chief

Online Article

Evaluation of radiographic magnification in lateral cephalograms obtained with different X-ray devices: Experimental study in human dry skull

José Rino Neto, João Batista de Paiva, Gilberto Vilanova Queiroz, Miguel Ferragut Attizzani, Hiroshi Miasiro Junior

Orthodontics. Diagnostic. Radiograph. Radiographic magnification.

Objective: The purpose of this study was to evaluate the influence of the magnification factor of the radiographic image in angular, linear and proportional measurements. 

 Methods: From a dried human skull where metallic spheres with predetermined size were fixed (1.0 mm), 14 radiographs were obtained in devices of three different manufacturers: Panoura, Instrumentarium and Tomeceph. The Pearson correlation test was used to investigate the relationship between the rate of radiographic magnification and the cephalometric measurements assessed. 

 Results: According to the results, the linear measurements showed a high positive correlation, pointing out great influence of the magnification factor, while the angular and proportional measurements did not correlate. 

 Conclusions: Comparisons between linear cephalometric measurements obtained with different devices from the same manufacturer showed maximum rates of expansion of 0.6%, 1.25% and 2.3%, respectively, for the devices from  Instrumentarium (OP-100, Instrumentarium, Finland), Panoura (10CSU, Yoshida, Japan) and Satelec/Tomeceph (XMind, Satelec/Tomeceph Orion Corporation, Finland). 

Distal movement of upper permanent molars using midpalatal mini-implant

Ana de Lourdes Sá de Lira, Sávio Prado, Mônica Tirre de Souza Araújo , Eduardo Franzotti Sant’Anna , Antônio Carlos de Oliveira Ruellas

Tooth movement. Orthodontic anchorage procedures. Hard palate.

Objective: To assess whether palatal mini-implants are effective as direct anchorage for distal movement of the upper molars. 

Methods: It was used an acrylic model of the upper dental arch. After making a groove in the region corresponding to dental alveolus, acrylic teeth were fixed in groove with #7 wax, with the roots being previously immersed in adhesive wax. The orthodontic appliance was placed according to the Edgewise technique and then a mini-implant (SIN, São Paulo, Brazil) was inserted at the site corresponding to the palatal raphe. A 0.019 x 0.025-in stainless steel archwire was made and attached to the upper arch with elastics. A transpalatal arch bar (0.019 x 0.025-in) was mounted and two hooks were soldered to it in order to retain chain elastics (Unitek, Brazil) to be connected to the mini-implant under a force of 1.5 N on each side. The maxillary model was immersed in water 40 times and photographed after each immersion, for observation of dental movements. Analysis of variance (ANOVA) and Tukey's test were employed for analyzing the obtained data. 

 Results: Molars displaced distally 3.1 mm, in average, with distal inclination ranging from 3 to 5 mm. 

Conclusions: Molar movements occurred due to distal inclination, with a slight rotation and no extrusive effect.

Determination of the force systems produced by different configurations of tear drop orthodontic loops

Guilherme Thiesen, Roberto Hideo Shimizu , Caio Vinicius Martins do Valle, Karyna Martins Valle-Corotti, Jefferson Ricardo Pereira, Paulo César Rodrigues Conti

Biomechanics. Orthodontic space closure. Tooth extraction. Orthodontics.

Objective: To determine the mechanical characteristics of teardrop loop with and without helix fabricated using different metal alloy compositions (stainless steel and beta-titanium), submitted to different intensities of bends preactivation (0° and 40°), and with different cross-sectional dimension of the wire used to build these loops (0.017 x 0.025-in and 0.019 x 0.025-in). 

Methods: Eighty loops used to close spaces were submitted to mechanical tests. The magnitudes of horizontal force, the moment/force ratio, and the load/deflection ratio produced by the specimens were quantified. Loops were submitted to a total activation of 5.0 mm and the values were registered for each 1.0 mm of activation. For statistic data analysis, a analysis of variance was performed and a Tukey's Multiple Comparison test was used as supplement, considering a 5% level of significance. 

Results: In general, teardrop loops with helix produced lower magnitudes of horizontal force and load/deflection ratio, and higher moment/force ratio than teardrop loops without helix. Among all analyzed variables, metal alloy composition presented greater influence in the horizontal force and in the load/deflection ratio. The moment/force ratio showed to be more influenced by the preactivation of loops for space closure.

Evaluation of the susceptibility to pigmentation of orthodontic esthetic elastomeric ligatures

Janine Soares Cavalcante, Marcelo de Castellucci e Barbosa, Márcio Costa Sobral

Esthetics. Staining. Photography. Ligature.

Objective: The purpose of this laboratory study was to evaluate changes in the pigmentation of esthetic elastomeric ligatures after immersion in a staining solution. 

Methods: Sixty ligatures were selected and divided into 12 groups according to their brand and also considering their condition, i.e., unstretched or stretched. The groups were divided into: Morelli (clear), TP Orthodontics (clear), American Orthodontics (clear), 3M/Unitek (clear), American Orthodontics (pearl color) and 3M/Unitek (pearl color), separated into groups of 5 unstretched and five stretched ligatures. Assessment of their color changes was performed by means of digital photograph and computer analysis using Adobe Photoshop. Standardized digital photographs were taken at T0 (before the staining process, with unstretched ligatures) and at T1 (following the 5-days staining process). The staining solution was composed of artificial saliva and foods with staining potential. At T1 the ligatures were either stretched or unstretched. 

Results: The results of this study showed that esthetic elastomeric ligatures are prone to staining. Among the evaluated brands, TP Orthodontics and American Orthodontics clear ligatures were the most stable. Moreover, 3M/Unitek pearl ligatures demonstrated statistically significant changes in all variables. 

Conclusions: Esthetic elastomeric ligatures are susceptible to staining and no statistically significant difference was found between unstretched or stretched ligatures, with the sole exception of the TP Orthodontics brand. The 3M/Unitek's pearl color ligatures displayed the greatest staining potential. 

Class II malocclusion treatment using high-pull headgear with a splint: A systematic review

Helder B. Jaco, Peter H. Buschang, Ary dos Santos-Pinto

Orthodontics. Angle Class II malocclusion. Treatment results.

Objective: To systematically review the scientific evidence pertaining to the effectiveness of high-pull headgear in growing Class II subjects. 

Methods: A literature survey was performed by electronic database search. The survey covered the period from January 1966 to December 2008 and used Medical Subject Headings (MeSH). Articles were initially selected based on their titles and abstracts; the full articles were then retrieved. The inclusion criteria included growing subjects between 8 to 15 years of age, Class II malocclusion treatment with high-pull headgear, and a control group with Class II malocclusion. References from selected articles were hand-searched for additional publications. Selected studies were evaluated methodologically. 

Results: Four articles were selected; none were randomized controlled trials. All of the articles clearly formulated their objectives and used appropriate measures. The studies showed that high-pull headgear treatment improves skeletal and dental relationship, distal displacement of the maxilla, vertical eruption control and upper molars distalization. One of the studies showed a slight clockwise rotation of the palatal plane; the others showed no significant treatment effect. The mandible was not affected by the treatment. 

Conclusion: While there is still a lack of strong evidence demonstrating the effects of high-pull headgear with a splint, other studies indicate that the AP relations improve due to distalization of the maxilla and upper molars, with little or no treatment effects in the mandible. Greater attention to the design should be given to improve the quality of such trials.

Original Article

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

Francyle Simões Herrera-Sanches, José Fernando Castanha Henriques, Guilherme Janson , Leniana Santos Neves, Karina Jerônimo Rodrigues Santiago de Lima, Rafael Pinelli Henriques, Lucelma Vilela Pieri

Angle Class II malocclusion. Corrective orthodontics. Functional orthodontic appliances.

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

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

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

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

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

Sagittal and vertical aspects of Class II division 1 subjects according to the respiratory pattern

Laura de Castro Cabrera, Luciana Borges Retamoso, Raul Magnoler Sampaio Mei, Orlando Tanaka

Angle Class II malocclusion. Mouth breathing. Breathing. Vertical dimension.

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Introduction: The teeth position, specially maxillary and mandibular incisors, in relation to basal bone and surrounding soft tissues must be considered in the elaboration of diagnosis, treatment planning and execution to obtain alignment, leveling, intercuspation, facial balance and harmony with stability of results. 

Objectives: To evaluate the modifications in the positioning of incisors in individuals with Angle Class II, division 1 malocclusion in two distinct moments of dentocraniofacial development, with mean interval of 2 years and 5 months.

Methods: The measures were obtained by means of lateral cephalograms of 40 individuals, being 23 nasal breathers (NB) and 17 mouth breathers (MB). The analyzed measures were overjet, overbite, UCI-NA, LCI-NB, UCI.NA, LCI.NB, UCI.SN, LCI.GoGn, UCI.LCI, ANB, GoGn.SN, and OccPl.SN. Statistical analysis (2-way repeated-measures ANOVA) was applied to verify intergroups differences. 

Results: Overjet, UCI-NA, LCI-NB, ANB, GoGn.SN, and OccPl.SN demonstrated statistically significant difference (p < 0.05) when observed the moment or the respiratory method. 

Conclusion: There is alteration in the positioning of incisors during growth with interference of the respiratory pattern.

Morphological evaluation of the active tip of six types of orthodontic mini-implants

Flávia Mitiko Fernandes Kitahara-Céia, Tatiana Feres Assad-Loss, José Nelson Mucha, Carlos Nelson Elias

Orthodontic anchorage procedures. Morphology. Orthodontics.

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Objective: To morphologically evaluate the active tip of six different types of self-drilling mini-implants for orthodontic anchorage. 

Methods: Images of the active tips of the mini-implants were obtained with a Zeiss optical microscope, Stemi 200-C with magnification of 1.6X. The images of the surface were viewed with the Axio Vision program (Zeiss, Jena, Germany) to calculate linear and angular measures. Mini-implant morphology and the details of tips and threads were also evaluated through Scanning Electronic Microscopy (SEM) (JEOL, model JSM5800 LV --- JEOL, Tokyo, Japan) with magnifications of 90X and 70X, respectively. The evaluation of the mini-implant taper shape was assessed using to the formula: (b - a) / (2 x D). 

Results: The following variables were measured: (1) active tip width, (2) major diameter of external thread, (3) minor diameter of internal thread and taper of the mini-implant, (4) number of threads and lead of the screw, (5) angle of thread, (6) flank width and (7) pitch width. 

Conclusion: Mini-implants from different manufacturers presented active tips with different characteristics. Mechanical testing is necessary to correlate the analyzed characteristics aiming to determine the best performance. 

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

Darwin Vaz de Lima, Karina Maria Salvatore de Freitas, Marcos Roberto de Freitas, Guilherme Janson , José Fernando Castanha Henriques, Arnaldo Pinzan

Corrective orthodontics. Angle Class II malocclusion. Treatment outcomes.

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

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

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

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

A comparative clinical study of the failure rate of orthodontic brackets bonded with two adhesive systems: Conventional and Self-Etching Primer (SEP)

Gladys Cristina Dominguez, André Tortamano, Luiz Vicente de Moura Lopes, Priscilla Campanatti Chibebe Catharino, Camillo Morea

Orthodontic brackets. Bonding. Dental adhesive.

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Objective: This study compared the clinical performance of orthodontic brackets bonded with Transbond adhesive paste after two priming systems: a two-stage conventional system (acid etching + Transbond XT adhesive primer) and a single-stage self-etching primer (SEP) (Transbond Plus). 

Methods: The sample comprised 480 metal brackets bonded to the teeth of 24 consecutive patients treated for 36 to 48 months. A split-mouth design was used for bonding, and both systems were used in each patient. Bracket failure rates for each system were analyzed; and failure causes as reported by the patients and the quadrant of teeth for which brackets failed were recorded. 

Results: The conventional system group had a failure rate of 5.41%, whereas the rate for SEP was 4.58%. In this group, there were 5 failures (38.4%) in the right maxillary quadrant, 2 (15.4%) in the left maxillary quadrant, 4 (30.8%) in the right mandibular quadrant, and 2 (15.4%) in the left mandibular quadrant. In the SEP group, there were 4 (36.4%) failures in the right maxillary quadrant, 1 (9%) in the left maxillary quadrant, 3 (27.3%) in the right mandibular quadrant, and 3 (27.3%) in the left mandibular quadrant. Results of descriptive statistical analysis and odds ratio did not show any significant differences between rates (p = 0.67). 

Conclusion: The clinical efficiency of SEP was similar to that of the conventional system. 

Effect of dental bleaching after bracket bonding and debonding using three different adhesive systems

Lucianna de Oliveira Gomes, Paula Mathias, Patricia Rizzo, Telma Martins de Araújo, Maria Cristina Teixeira Cangussu

Dental bleaching. Orthodontic brackets. Photography. Primer.

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Objective: To evaluate the influence of bonding and debonding of orthodontic brackets on dental in-home bleaching, taking into account three different adhesive systems. 

Methods: Forty-four bovine incisors were divided into four groups according to the primer system used for orthodontic bracket bonding. Following the debonding of orthodontic brackets, the teeth were stored in staining solution for 96 hours. Then, teeth were whitened using 10% carbamide peroxide for two weeks at a 6-hour-a-day regime. Standardized digital photographs were taken at the following intervals: T0 (initial); T1 (after debonding); T2 (after pigmentation); T3, T4 and T5 representing 1, 7, and 14 days of bleaching. Repeatability and stability tests were carried out to check the method accuracy. Images were analyzed using Adobe Photoshop 7.0 software considering (L*a*b*)color coordinate values  and a modified color difference total ([]E'). 

Results: The results of this study (ANOVA and Tukey; p < 0.01) demonstrated that after 7 days of bleaching, experimental groups showed significantly less teeth whitening compared to the control group. However, there were no significant color differences between the groups after 14 days, according to values of lightness (L*). 

Conclusions: Regardless of the adhesive primer system applied, bonding and debonding of orthodontic brackets alters the outcome of tooth whitening in the first 7 days of bleaching, however it has no influence on the whitening of the dental structure after 14 days of in-home dental bleaching with 10% carbamide peroxide.

Assessment of the dimensions and surface characteristics of orthodontic wires and bracket slots

Gabriel Schmidt Dolci , Ana Maria Spohr, Eduardo Rigon Zimmer, Ernani Menezes Marchioro

Orthodontic brackets. Orthodontic wires. Friction.

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Objective: The purpose of this study was to evaluate the dimensions and surface characteristics of orthodontic wires and bracket slots of different commercial brands. 

Methods: Thirty metallic brackets (0.022 x 0.028-in and 0.022 x 0.030-in) were divided in three groups: DYN/3M group = Dyna-Lock, 3M/Unitek (stainless steel, or SS); STD/MO group = Slim Morelli (SS); and Ni-Free/MO group = Slim Morelli (Ni-Free). The stainless steel wires (0.019 x 0.025-in) were divided into two groups: MO group = Morelli; and 3M group = 3M/Unitek. The bracket and wire measurements were done by two methods: (a) Surface Electron Microscopy (SEM), and (b) Profile projection. The surface analysis was done qualitatively, based on SEM images and/or by a rugosimeter. The quantitative results were analyzed by ANOVA with Tukey's test (p < 0.05) and Student's t test. 

Results: A significant difference in the dimensions of slots was observed, and the NiFree/MO group showed the greatest changes when compared to the other groups. The analysis of surface topography of the brackets indicated greater homogeneity of the metallic matrix for DYN/3M and STD/MO groups. As for the dimensions of the wires, groups showed statistically different mean heights. 

Conclusions: It was concluded that wires and brackets slots can present altered dimensions, which might directly and unintentionally affect the planned tooth movement.

Shear bond strength of metallic and ceramic brackets using color change adhesives

Aisha de Souza Gomes Stumpf, Carlos Bergmann, José Renato Prietsch, Juliane Vicenzi

Orthodontic brackets. Dental materials. Adhesives.

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Objective: To determine the shear bond strength of orthodontic brackets using color change adhesives that are supposed to aid in removing excess of bonding material and compare them to a traditional adhesive. 

Methods: Ninety metallic and ninety ceramic brackets were bonded to bovine incisors using two color change adhesives and a regular one. A tensile stress was applied by a universal testing machine. The teeth were observed in a microscope after debonding in order to determine the Adhesive Remnant Index (ARI). 

Results: The statistical analysis (ANOVA, Tukey, and Kruskall-Wallis tests) demonstrated that the mean bond strength presented no difference when metallic and ceramic brackets were compared but the bond resistance values were significantly different for the three adhesives used. The most common ARI outcome was the entire adhesive remaining on the enamel. 

Conclusions: The bond strength was similar for metallic and ceramic brackets when the same adhesive system was used. ARI scores demonstrated that bonding with these adhesives is safe even when ceramic brackets were used. On the other hand, bond strength was too low for orthodontic purposes when Ortho Lite Cure was used.

Assessment of motivation, expectations and satisfaction of adult patients submitted to orthodontic treatment

Patrícia Gomide de Souza Andrade Oliveira, Estevam Rubens Utumi, Jairo Curado de Freitas

Orthodontics. Psychology. Behavior. Adults.

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Objective: The purpose of this study was to analyze the psychological aspects of adult patients who sought and underwent orthodontic treatment, evaluating their expectations and discomfort during treatment, as well as their satisfaction after completion of dental movement. 

Results and Conclusions: Data obtained from previous published papers, and also from questionnaires answered by 54 patients, showed that adult patients stood out for their attention to details and high interest in the esthetic improvements provided by treatment, and also for a greater perception of their initial malocclusion. On the other hand, the same data showed that adult patients, once informed about the limitations of their treatment and having confidence on the orthodontist, presented a high level of satisfaction with treatment results, revealing themselves as good patients for indication and execution of orthodontic procedures.

Expectations of orthodontic treatment in adults: The conduct in orthodontist/patient relationship

Ricardo Alves de Souza, André Frutuoso de Oliveira, Suélem Maria Santana Pinheiro, Jefferson Paixão Cardoso, Maria Beatriz Borges de Araújo Magnani

Orthodontics. Adults. Facial pain. Malocclusion. Dental esthetics.

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Introduction: The high demand for orthodontic treatment, evidenced over the last few decades, has been justified mainly by the greater importance given to facial esthetics, influencing individual's self esteem. However, the professional frequently does not meet all the patient's expectations, for not establishing good communication and not knowing about the critical points during orthodontic treatment. 

Objective: The aim of this study was to elucidate patients' desires and doubts regarding orthodontic treatment, by means of a survey applied to 60 adult patients. 

Results: The analysis of results revealed that most individuals (38.3 %) noticed treatment success after its conclusion. Occlusion deviation was pointed out by 66.7 % as the main reason for seeking treatment, and esthetics ranked as second (with 48.3 %). Treatment time was considered within the prediction by 46.7% of the interviewees and the results were judged as very good by 43.3 %. The social relations of most participants were not affected by treatment (73.3 %). Also, 58.3 % of the interviewees reported pain as the main complaint and 53.3 % found it difficult to use dental floss. Most participants saw the orthodontist as a professional who was concerned about their health (76.7 %), and believed that he/she was more able to treat them (96.6 %) when compared with the general practitioner. 

Conclusion: The orthodontist/patient relationship enables an understanding of the expectations regarding orthodontic treatment, resulting in greater motivation and cooperation, leading to a successful outcome. 

Evaluation of the influence of dental bleaching with 35% hydrogen peroxide in orthodontic bracket shear bond strength

Marcus Vinicius Neiva Nunes do Rego, Roanselli Marllon Lima dos Santos, Leanne Matias Portela Leal, Carlos Gustavo Silva Braga

Orthodontic brackets. Dental bleaching. Tensile strength.

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Objective: The purpose of this study was to evaluate, in vitro, the bond strength of brackets bonded to premolars previously subjected to bleaching with a 35% hydrogen peroxide. 

Methods: Twenty one healthy premolars were selected and randomly divided into three groups (n = 7). Group I (G1) included teeth that were not submitted to bleaching. The enamel surfaces of Groups II (G2) and III (G3) were submitted to a bleaching process with 35% hydrogen peroxide (Whiteness HP Maxx). On Group II (G2), after bleaching, the teeth were stored for 24 hours in distilled water at 98.6 °F, and then, premolar metallic brackets were bonded using Transbond XT (3M) resin. Group III (G3) was submitted to the same procedure seven days after bleaching. After bonding, all teeth were stored in distilled water at 98.6 °F for 24 hours. All groups were submitted to a traction test using an EMIC DL2000 universal testing machine at a speed of 0.5 mm/min. 

Results and Conclusion: The bracket resistance to debonding was compared between the groups by the Kruskal-Wallis nonparametric test (p < 0.05) and it was verified that the bleaching agent significantly reduced bracket adhesion when bonded 24 hours after bleaching. However, seven days after bleaching, there was no significant difference on the resistance to debonding among groups G1 (19,52 kgf) and G3 (18,44 kgf), meaning that it is necessary to wait longer after bleaching to bond brackets.

Maxillary incisor retraction: Evaluation of different mechanisms

Antônio Carlos de Oliveira Ruellas, Matheus Melo Pithon, Rogério Lacerda dos Santos

Fixed orthodontics. Malocclusion. Maxillary incisors.

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Objective: To mechanically evaluate different systems used for incisors retraction. 

Methods: Three different methods for incisors retraction using 0.019 x 0.025-in stainless steel wire were evaluated. The samples were divided into three groups: Group A (retraction arch with 7-mm high vertical hooks); Group G3 (elastic chain attached to the mini-implant and to the 3-mm stainless steel hook soldered to the retraction arch); Group G6 (elastic chain attached to the mini-implant and to the 6-mm stainless steel hook soldered to the retraction arch). A dental mannequin was used for evaluation in order to simulate the desired movements when the device was exposed to a heat source. The analysis of variance (ANOVA) and the Tukey test were used (p < 0.05). 

Results: The results demonstrated that Groups G3 and G6 exhibited less extrusion and less incisor inclination during the retraction phase (p < 0.05). With regard to incisor extrusion, statistically significant differences were observed between Groups A and G3, and between Groups A and G6 (p < 0.05). Regarding incisor inclination, statistically significant differences were observed between the three systems evaluated (p < 0.05). 

Conclusions: Arches with 6-mm vertical hooks allow the force to be applied on the center of resistance of the incisors, thus improving mechanical control when compared with the other two systems. 

Changes on facial profile in the mixed dentition, from natural growth and induced by Balters' bionator appliance

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

Activator appliances. Angle Class II malocclusion. Cephalometry.

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Objective: The purpose of this study was to evaluate the facial profile changes induced by Balters' bionator appliance in Class II division 1 patients, at mixed dentition stage. 

Methods: The sample consisted of 28 pre-pubertal individuals at stages 1 and 2 of skeletal maturation (CVM), which were divided in two groups. The experimental group consisted of 14 individuals (7 boys and 7 girls, initial mean age of 8y12m) which were treated with Balters' bionator appliance for 14.7 months. The effects of treatment were compared to a control group of 14 subjects (7 boys and 7 girls, initial mean age of 8y5m) with Class II malocclusion, division 1, not orthodontically treated, which were followed up for 15.4 months. The statistical analysis was performed using Student?s t test, at a significance level of 5%. 

Results: The results showed that the Balters' bionator appliance promoted a significant increase on the mentolabial angle, in addition to demonstrating a tendency to reduce the facial skeletal convexity, to restrict the maxillary growth and to increase the nasolabial angle and the lower anterior facial height. 

Conclusion: It can be concluded that the Balters' bionator appliance improved the facial profile of children treated at mixed dentition stage. 

Comparative study of the soft tissue of young Japanese-Brazilian, Caucasian and Mongoloid patients

Thais Maria Freire Fernandes, Arnaldo Pinzan , Renata Sathler, Marcos Roberto de Freitas, Guilherme Janson , Fabiano Paiva Vieira

Ethnic groups. Reference values. Orthodontics.

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Objective: To determine the normality mean values in the soft tissue cephalometric measurements of young Japanese-Brazilian, with normal occlusion and compare the results of the variables with compatible samples of young Caucasians and Mongoloids. 

Methods: Forty radiographs of young Caucasians, 32 of Japanese-Brazilians and 33 of Mongoloids were used. The three samples presented individuals with normal occlusion and well-balanced face. The samples were divided by gender due to the soft tissue characteristics and to facilitate comparison. The following statistical tests were performed: Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) with p < 0.05. 

Results: The Japanese-Brazilian sample of females showed thinner soft tissues in the nasion region and smaller nose when compared to the Caucasians. The Mongoloid sample showed thinner tissues in the supramentonian and pogonion regions. In males, the Japanese-Brazilians had thinner tissues in the nasion region; thicker lower lip and supramentonian region in comparison to the Caucasian sample. For the Mongoloid, soft tissue was thicker in the glabella and ANS-Sn regions. 

Conclusion: It is necessary to use specific soft tissue standards for this mixed race.

Assessing the predictability of ANB, 1-NB, P-NB and 1-NA measurements on Steiner cephalometric analysis

Ana Cláudia Laureano Navarro, Luiz Sérgio Carreiro, Claudenir Rossato, Ricardo Takahashi, Carlos Eduardo de Oliveira Lima

Growth and development. Radiography. Tooth movement.

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Objective: To evaluate, in the initial and final stages of corrective orthodontic treatment, the predictability of the ANB, 1-NB, PNB and 1-NA during case individualization, which considers the characteristics of the patient, professional experience and the mechanics to be used. 

Methods: Ninety patients were selected at the State University of Londrina (UEL, Brazil), presenting Angle Class I and II malocclusions, treated with and without extraction of four premolars and divided into three groups: Horizontal, balanced and vertical. The cephalometric variables were evaluated in the initial, prognosis and final stages of treatment in order to observe the behavior of the estimates, or how they were higher or lower than the values obtained. 

Results: It was noticed the influence of the facial pattern on the behavior of the measures examined, the values proposed for the ANB were statistically different from values obtained at the end of the treatment; in the vertical group the final value was the one that most approached the proposed value; regarding 1-NB the values proposed with the Steiner analysis for the balanced and vertical groups were not achieved. For P-NB, there was no difference between genders. For 1-NA it was observed that the values obtained at the end of treatment differ from estimates in the three groups. 

Conclusions: The limitations of the estimates of the measures do not invalidate its clinical or teaching use, if aware of its deficiencies, the analysis can be used with restrictions.

BBO Case Report

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

Matheus Melo Pithon

Open bite. Tooth extraction. Corrective orthodontics.

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

Special Article

Vertical control in the Class III compensatory treatment

Márcio Costa Sobral, Fernando Antônio Lima Habib, Ana Carla de Souza Nascimento

Orthodontics. Class III malocclusion. Camouflage.

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Introduction: Compensatory orthodontic treatment, or simply orthodontic camouflage, consists in an important alternative to orthognathic surgery in the resolution of skeletal discrepancies in adult patients. It is important to point that, to be successfully performed, diagnosis must be detailed, to evaluate, specifically, dental and facial features, as well as the limitations imposed by the magnitude of the discrepancy. The main complaint, patient's treatment expectation, periodontal limits, facial pattern and vertical control are some of the items to be explored in the determination of the viability of a compensatory treatment. Hyperdivergent patients who carry a Class III skeletal discrepancy, associated with a vertical facial pattern, with the presence or tendency to anterior open bite, deserve special attention. In these cases, an efficient strategy of vertical control must be planned and executed. 

Objective: The present article aims at illustrating the evolution of efficient alternatives of vertical control in hiperdivergent patients, from the use, in the recent past, of extra-oral appliances on the lower dental arch (J-hook), until nowadays, with the advent of skeletal anchorage. But for patients with a more balanced facial pattern, the conventional mechanics with Class III intermaxillary elastics, associated to an accentuated curve of Spee in the upper arch and a reverse Curve of Spee in the lower arch, and vertical elastics in the anterior region, continues to be an excellent alternative, if there is extreme collaboration in using the elastics. 

Dental Press Journal of Orthodontics - v. 18, no. 2 Download full issue pdf