Dental Press Journal of Orthodontics – ISSN 2176-9451
Dental Press J. Orthod.
v. 19, no. 4
July / August
“To have a new language is to have a new soul.”
Juan Ramón Jiménez, Spanish poet.
Globalization and internationalization are terms of the corporate world. In this scenario, mastering the English language is indispensable and with Brazilian science is not different. CAPES (Coordination for the Improvement of Higher Education Personnel) and CNPq (National Council for Scientific and Technological Development) have encouraged postgraduate programs and scientific research to effusively enter into the international scenario. However, the Shakespearean language is the foundation of this building. CAPES and CNPq programs have advanced and are good examples, despite Brazilian one-legged basic education system. Science without Borders is a nationwide scholarship program funded by the Brazilian federal government and is a good example we should be proud of. The program has expanded and, nowadays, includes not only postgraduate, but also undergraduate programs. Nevertheless, supply exceeds demand, especially because most undergraduate and postgraduate students do not master the English language. The solution was to establish the program English without Borders.
With a worldwide, clinically and scientifically, renowned Dentistry, Brazilian journals have increasingly sought internationalization in the counterflow of federal support. Internationalization is, in general terms, the need for communicating in a single language.1 In Brazilian Dentistry, six out of the seven journals indexed in SCOPUS are fully published in English. That is how our Dental Press Journal of Orthodontics (DPJO), with an ear to the world, has been disclosed: in English, since 2010, as well as in Portuguese. This is a milestone in the internationalization of this journal which has been sculptured for nearly a decade.
Speaking does not guarantee us to be heard. For this reason, in addition to the need of establishing communication in the language shared by science, it is of paramount importance that the journal content be disclosed. Thus, step-by-step, DPJO was being embraced by the major international databases: SciELO (2005), SCOPUS (2008) and, recently, PubMed (2013). We acknowledge that publishing a journal in a universal language globally increases reader’s interest. However, what would be the impact of this process of internationalization on overseas authors?
We are aware that the number of articles written by Brazilian orthodontists published in international journals has increased in the last decades.2 Nevertheless, the interest in publishing in Brazilian journals did not follow the same pace. In 2012, when DPJO was not yet indexed in PubMed, only 3% of articles were submitted by foreign researchers. These articles came from India, Malaysia and Iran and did not fulfill acceptable methodological quality. After being indexed in PubMed, the number of submissions by foreign authors grew dramatically. By analyzing data from the last twelve months (Aug, 2013 – Jul, 2014), we notice that one third of articles submitted to DPJO come from different countries such as Canada, the United States, Italy, Colombia, Pakistan, India, Mexico, Saudi Arabia, Singapore and Iran. An increase that surpasses 1000%. Within this period, DPJO acceptance rate was of 30% for articles submitted by Brazilian authors and 10% for overseas authors. These numbers lead us to infer that not only the amount of articles submitted by overseas researchers has increased, but also the number of high-quality articles reaching our brooks.
A new language renews the soul and provides those who seek leadership in a high-quality corporate world with courage. Therefore, our young journal has followed the steps of the Spanish poet cited in the epigraph whose exile led him to learn a new communication tool capable of spreading his art throughout the literary world. We go on publishing in the Portuguese language. Thus, we have not renounced the language of Camões, but acquired a new soul instead.
Asymmetries not greater than 5.6 mm go unnoticed by laypeople
The literature extensively reports the need for a certain degree of asymmetry between the right and left sides of the face, which give facial contour a natural form. Should both sides of the face be completely symmetrical, they give the person an artificial and unpleasant look. Nevertheless, what is the acceptable limit of normal asymmetry? With a view to answering this question, English researchers conducted a study1 in which they analyze frontal facial photographs of female and male patients (Fig 1) and develop different degrees of asymmetry in the chin area. The same images were analyzed by laypeople, students and professionals of Dentistry, as well as dental-surgeons and orthodontists in terms of perception of different degrees of facial asymmetry in male and female patients. Results revealed that the two major factors influencing perception of asymmetry were the evaluator and the degree of asymmetry. Orthodontists proved much more critical of asymmetry in comparison to laypeople. The more asymmetric was an image, the more noticeable asymmetry was. The research outcomes prove necessary to assess each case individually before referring a patient to surgery.
The use of bisphosphonates does not contraindicate orthodontic and other types of treatment!
Bisphosphonates. Osteomyelitis. Osteonecrosis. Orthodontics. Implants.
How sample size influences research outcomes
Sample calculation. Sample size. Clinical trial. Methodology. Scientific evidence.
Sample size calculation is part of the early stages of conducting an epidemiological, clinical or lab study. In preparing a scientific paper, there are ethical and methodological indications for its use. Two investigations conducted with the same methodology and achieving equivalent results, but different only in terms of sample size, may point the researcher in different directions when it comes to making clinical decisions. Therefore, ideally, samples should not be small and, contrary to what one might think, should not be excessive. The aim of this paper is to discuss in clinical language the main implications of the sample size when interpreting a study.
An interview with Nigel Harradine
Dr. Nigel Harradine qualified as a dental surgeon from Guys Hospital, London and also underwent undergraduate medical training, qualifying again from Guys. A medical house physician post followed at Guys and then a year as an intern in London, Ontario before he settled on orthodontics as his chosen specialty and returned to the United Kingdom. A year of full-time general dental practice was followed by the two-year orthodontic course at the Royal Dental Hospital, London and Kingston Hospital, Surrey where he studied under Prof. Bill Houston and Harry Orton the Consultant orthodontist. In 1981, Dr. Nigel went to the Eastman Dental Hospital, initially as a lecturer and then as a senior lecturer in orthodontics. Since 1984 he has been a consultant at Bristol Dental Hospital and School where he is in charge of the undergraduate program and fully involved in the postgraduate teaching. Dr. Nigel has published innumerous papers, related to self-ligating brackets, TADs, orthognathic surgery, functional appliances, including a random prospective trial of the effects of third molar extraction on later incisor crowding. He has also contributed invited chapters to a number of textbooks. With David Birnie, Nigel Harradine has co-presented the annual Excellence in Orthodontics Course since 1987 and has lectured extensively throughout the United Kingdom including multiple presentations to the British Orthodontic Conference and the Consultant Orthodontists Group Symposium, including the Chapman Lecture, the Ballard Memorial Lecture, the Northcroft Lecture and the Webb Johnson Lecture. In total, Nigel has given 390 external invited presentations on the UK. In addition to Excellence in Orthodontics courses overseas, Nigel has delivered invited lectures and courses in Australia, France, Germany, Israel, Mexico, Malaysia, New Zealand, Norway, Serbia, South Africa, Switzerland, The Netherlands and the USA, where he has given six presentations to the Annual Session of the AAO, a two day course at Chapel Hill and keynote presentations to the Pacific Coast Society and in 2010 to the College of Diplomates of the American Board of Orthodontics – a total of 170 presentations. Away from the chairside and the podium, Nigel’s roles have included being the President of the British Dental Association hospitals group, Chairman of the British Orthodontic Society scholarship committee, Chairman of the English Royal College working party on Read Coding, Secretary for seven years of the Royal College Orthodontic Audit working party, Secretary of the British Orthodontic Conference Organizing Committee, Chairman of the British Orthodontic Society Computer Users Group and a member of the British Orthodontic Society Council. He is a past Chairman of the Consultant Orthodontists Group of the BOS and a previous Clinical Director of Bristol Dental Hospital. Nigel was the initiator and inaugural chairman of the British Orthodontic Society Foundation which supports research and teaching in Orthodontics. Dr. Nigel kindly agreed to granted this interview to Dental Press Journal, and very interesting questions were formulated by Dr. Ricardo Moresca, Weber Ursi and Jonh Pobanz and myself. The main issue was SLB systems and we hope you can enjoy the wonderful experience and knowledge from Dr. Nigel Harradine.
Influence of initial occlusal severity on time and efficiency of Class I malocclusion treatment carried out with and without premolar extractions
Class I malocclusion. Efficiency. Time. Tooth extraction.
Introduction: The aim of this retrospective study was to compare the occlusal outcomes, duration and efficiency of Class I malocclusion treatment carried out with and without premolar extractions in patients with different degrees of initial malocclusion severity.
Methods: Complete records of 111 patients were obtained and divided into two groups: Group 1 consisted of 65 patients at an initial mean age of 13.82 years old treated with four premolar extractions; whereas Group 2 consisted of 46 patients at an initial mean age of 14.01 years old treated without extractions. Two subgroups were obtained from each group (1A, 1B, 2A and 2B) with different degrees of malocclusion severity according to the initial values of PAR index. Compatibility was assessed using chi-square and t-tests. The subgroups were compared by means of Analysis of Variance (ANOVA).The variables that might be related to treatment duration and efficiency were assessed using the multiple linear regression analysis.
Results: Initial malocclusion severity was positively related to the amount of occlusal correction and consequently to a higher efficiency index. Moreover, extraction protocol showed a positive relationship with treatment duration and a negative relationship with treatment efficiency.
Conclusion: Extraction and non-extraction protocols for correction of Class I malocclusion provide similar satisfactory results; however, the extraction protocol increases the overall treatment duration. Orthodontic treatment is more efficient in cases with high initial malocclusion severity treated with a non-extraction protocol.
Comparative study of dental cephalometric patterns of Japanese-Brazilian, Caucasian and Mongoloid patients
Ethnic group. Reference standards. Orthodontics.
Introduction: The objective of this study was to identify the patterns of dental variables of adolescent Japanese-Brazilian descents with normal occlusion, and also to compare them with a similar Caucasian and Mongoloid sample.
Methods: Lateral cephalometric radiographs were used to compare the groups: Caucasian (n = 40), Japanese-Brazilian (n = 32) and Mongoloid (n = 33). The statistical tests used were one-way ANOVA and ANCOVA. The cephalometric measurements used followed the analyses of Steiner, Tweed and McNamara Jr.
Results: Statistical differences (P < 0.05) indicated a smaller interincisal angle and overbite for the Japanese-Brazilian sample, when compared to the Caucasian sample, although with similar values to the Mongoloid group.
Conclusion: The dental patterns found for the Japanese-Brazilian descents were, in general, more similar to those of the Mongoloid sample.
Skeletal maturation in individuals with Down’s syndrome: Comparison between PGS curve, cervical vertebrae and bones of the hand and wrist
Down’s syndrome. Cervical vertebrae. Age determination by skeleton. Sesamoid bones.
Introduction: This study was conducted with the aim of adapting the methods developed by Martins and Sakima to assess skeletal maturation by cervical vertebrae in the pubertal growth spurt (PGS) curve. It also aimed to test the reliability and agreement between those methods and the method of hand and wrist radiograph when compared two by two and all together.
Methods: The sample comprised 72 radiographs, with 36 lateral radiographs of the head and 36 hand-wrist radiographs of 36 subjects with Down’s syndrome (DS), 13 female and 23 male, aged between 8 years and 6 months and 18 years and 7 months, with an average age of 13 years and 10 months.
Results and Conclusions: Results revealed that adapting the methods developed by Martins and Sakima to assess skeletal maturation by cervical vertebrae in the curve of PGS is practical and useful in determining the stage of growth and development of individuals. The stages of maturation evaluated by cervical vertebrae and ossification centers observed in radiographs of the hand and wrist were considered reliable, with excellent level of agreement between the methods by Hassel and Farman as well as Baccetti, Franchi and McNamara Jr and Martins and Sakima. Additionally, results revealed an agreement that ranged between reasonable to good for the three methods used to assess the skeletal maturation, showing statistical significance.
In vitro cytotoxicity of self-curing acrylic resins of different colors
Acrylic resins. Cell culture techniques. Cytotoxins.
Objective: The aim of this study was to assess the in vitro cytotoxicity of acrylic resins of different colors over time.
Methods: Specimens were divided into 4 groups (n = 6) according to the color of the acrylic resin (Orto Class, Clássico, Campinas, São Paulo, Brazil): Group 1: clear acrylic resin; group 2: pink acrylic resin; group 3: blue acrylic resin and group 4: green acrylic resin. All specimens were fabricated according to the mass manipulation technique and submitted to mechanical polishing protocol. The control was performed with an amalgam specimen (C+), a glass specimen (C-) and cell control (CC). Specimens were immersed in Minimum Eagle’s Medium (MEM) and incubated for 24 h at 37o C. The extracts from the experimental material were filtered and mixed with L929 fibroblast. Cytotoxicity was evaluated at 4 different times, 24, 48, 72 and 168 h. After contact, cells were incubated for 24 h and added to 100 µ of 0.01% neutral red dye. The cells were incubated for 3 h for pigment incorporation and fixed. Cells viability was determined by a spectroscopic (BioTek, Winooski, Vermont, USA) with a 492-nm wavelength λ=492 nm).
Results: There were no statistical differences between the experimental groups and the CC and C- groups.
Conclusion: Clear, pink, blue and green self-curing acrylic resins fabricated by means of the mass manipulation technique and mechanically polished are not cytotoxic. Neither the pigment added to the self-curing acrylic resin nor the factor of time influenced the cytotoxicity of the material.
Three-dimensional dental arch changes of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusion
Orthodontics. Orthognathic surgery. Malocclusion. Dental models.
Introduction: This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods.
Methods: Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient’s dental arches.
Results: During orthodontic preparation, the maxillary and mandibular transverse dimensions measured at the premolar regions were increased and maintained throughout the follow-up period. Intercanine width was increased only in the upper arch during orthodontic preparation. Maxillary arch length was reduced during orthodontic finalization, only. Upper and lower arch depths were stable in the study periods. Differences between centroid and gingival changes suggested that upper and lower arch premolars buccaly proclined during the pre-surgical period.
Conclusions: Maxillary and mandibular dental arches presented transverse expansion at premolar regions during preoperative orthodontic preparation, with a tendency towards buccal tipping. The transverse dimensions were not altered after surgery. No sagittal or vertical changes were observed during the follow-up periods.
Lateral cephalometric diagnosis of asymmetry in Angle Class II subdivision compared to Class I and II
Facial asymmetry. Malocclusions. Radiography. Cephalometry.
Introduction: Lateral cephalometric radiographs are traditionally required for orthodontic treatment, yet rarely used to assess asymmetries.
Objective: The objective of the present study was to use lateral cephalometric radiographs to identify existing skeletal and dentoalveolar morphological alterations in Class II subdivision and to compare them with the existing morphology in Class I and II relationship.
Material and Methods: Ninety initial lateral cephalometric radiographs of male and female Brazilian children aged between 12 to 15 years old were randomly and proportionally divided into three groups: Group 1 (Class I), Group 2 (Class II) and Group 3 (Class II subdivision). Analysis of lateral cephalometric radiographs included angular measurements, horizontal linear measurements and two indexes of asymmetry that were prepared for this study.
Results: In accordance with an Index of Dental Asymmetry (IDA), greater mandibular dental asymmetry was identified in Group 3. An Index of Mandibular Asymmetry (IMA) revealed less skeletal and dental mandibular asymmetry in Group 2, greater skeletal mandibular asymmetry in Group 1, and greater mandibular dental asymmetry in Group 3.
Conclusion: Both IDA and IMA revealed greater mandibular dental asymmetry for Group 3 in comparison to Groups 1 and 2. These results are in accordance with those found by other diagnostic methods, showing that lateral cephalometric radiography is an acceptable method to identify existing skeletal and dentoalveolar morphological alterations in malocclusions.
Lateral cephalometric radiograph versus lateral nasopharyngeal radiograph for quantitative evaluation of nasopharyngeal airway space
Radiology. Nasopharynx. Orthodontics.
Objective: This study compared lateral radiographs of the nasopharynx (LN) and lateral cephalometric radiographs (LC) used to assess nasopharyngeal airway space in children.
Material and Methods: One examiner measured the nasopharyngeal space of 15 oral breathing patients aged between 5 and 11 years old by using LN and LC. Both assessments were made twice with a 15-day interval in between. Intergroup comparison was performed with t-tests (P < 0.05).
Results: Comparison between LN and LC measurements showed no significant differences.
Conclusion: Lateral cephalometric radiograph is an acceptable method used to assess nasopharyngeal airway space.
Effectiveness of orofacial myofunctional therapy in orthodontic patients: A systematic review
Myofunctional therapy. Orthodontics. Malocclusion.
Objective: The aim of the present systematic review was to determine the existence of scientific evidence demonstrating the effectiveness of orofacial myofunctional therapy (OMT) as an adjuvant to orthodontic treatment in individuals with orofacial disorders. A further aim was to assess the methodological quality of the studies included in the review.
Methods: An electronic search was performed in eight databases (Medline, BBO, LILACS, Web of Science, EMBASE, BIREME, Cochrane Library and SciELO) for papers published between January 1965 and March 2011, with no language restrictions. Selection of articles and data extraction were performed by two independent researchers. The quality of the selected articles was also assessed.
Results: Search strategy resulted in the retrieval of 355 publications, only four of which fulfilled the eligibility criteria and qualified for final analysis. All papers selected had a high risk of bias.
Conclusions: The findings of the present systematic review demonstrate the scarcity of consistent studies and scientific evidence supporting the use of OMT in combination with orthodontic treatment to achieve better results in the correction of dentofacial disorders in individuals with orofacial abnormalities.
Orthodontic post-adjustment pain control with acupuncture
Orthodontics. Acupuncture analgesia. Pain.
Objective: This study aimed to evaluate the analgesic efficacy of systemic acupuncture therapy on the pain caused after orthodontic adjustments.
Methods: An initial sample of 30 orthodontic patients with fixed appliances monthly adjusted was selected; however, only 11 participants completed the study. For this reason, final sample comprised these patients’ data only. Initially, average pain levels were assessed at different periods by means of an analogue visual scale (VAS) for three months without acupuncture. In the following three months, the volunteers were submitted to systemic acupuncture sessions on Hegu (LI4) and Jiache (St6) points,before orthodontic adjustments were carried out.
Results: Results revealed statistically significant reduction in pain level indexes both for men (P = 0.030) and women (P = 0.028) when acupuncture therapy was performed prior to orthodontic adjustment. Patients did not present any side effects.
Conclusion: Acupuncture is a safe and effective method in reducing orthodontic post-adjustment pain.
Tooth-size discrepancy: A comparison between manual and digital methods
Dental models. Computer-assisted diagnosis. Three-dimensional imaging.
Introduction: Technological advances in Dentistry have emerged primarily in the area of diagnostic tools. One example is the 3D scanner, which can transform plaster models into three-dimensional digital models.
Objective: This study aimed to assess the reliability of tooth size-arch length discrepancy analysis measurements performed on three-dimensional digital models, and compare these measurements with those obtained from plaster models.
Material and Methods: To this end, plaster models of lower dental arches and their corresponding three-dimensional digital models acquired with a 3Shape R700T scanner were used. All of them had lower permanent dentition. Four different tooth size-arch length discrepancy calculations were performed on each model, two of which by manual methods using calipers and brass wire, and two by digital methods using linear measurements and parabolas.
Results: Data were statistically assessed using Friedman test and no statistically significant differences were found between the two methods (P > 0.05), except for values found by the linear digital method which revealed a slight, non-significant statistical difference.
Conclusions: Based on the results, it is reasonable to assert that any of these resources used by orthodontists to clinically assess tooth size-arch length discrepancy can be considered reliable.
In vitro study of color stability of polycrystalline and monocrystalline ceramic brackets
Color. Ceramics. Orthodontic brackets.
Objective: The aim of this in vitro study was to analyze color stability of monocrystalline and polycrystalline ceramic brackets after immersion in dye solutions.
Methods: Seven ceramic brackets of four commercial brands were tested: Two monocrystalline and two polycrystalline. The brackets were immersed in four dye solutions (coffee, red wine, Coke and black tea) and in artificial saliva for the following times: 24 hours, 7, 14 and 21 days, respectively. Color changes were measured by a spectrophotometer. Data were assessed by Multivariate Profile Analysis, Analysis of Variance (ANOVA) and Multiple Comparison Tests of means.
Results: There was a perceptible change of color in all ceramic brackets immersed in coffee (ΔE* Allure = 7.61, Inspire Ice = 6.09, Radiance = 6.69, Transcend = 7.44), black tea (ΔE* Allure = 6.24, Inspire Ice = 5.21, Radiance = 6.51, Transcend = 6.14) and red wine (ΔE* Allure = 6.49, Inspire Ice = 4.76, Radiance = 5.19, Transcend = 5.64), but no change was noticed in Coke and artificial saliva (ΔE < 3.7).
Conclusion: Ceramic brackets undergo color change when exposed to solutions of coffee, black tea and red wine. However, the same crystalline structure, either monocrystalline or polycrystalline, do not follow the same or a similar pattern in color change, varying according to the bracket fabrication, which shows a lack of standardization in the manufacturing process. Coffee dye produced the most marked color changes after 21 days of immersion for most ceramic brackets evaluated.
BBO Case Report
Two-phase treatment of patients with crossbite and tendency toward skeletal Class III malocclusion
Angle Class III malocclusion. Palatal expansion technique. Maxilla.
Angle Class III malocclusion is characterized by an inadequate anteroposterior dental relationship which may or may not be accompanied by skeletal changes. In general, patients are distressed by a significantly compromised facial aspect which, when associated with a deficient middle third, encourages patients to seek treatment. This article reports a two-phase treatment carried out in a female patient aged six years and six months with a tendency towards a Class III skeletal pattern. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO). It is representative of the Discrepancy Index (DI) category, and fulfills part of the requirements for obtaining BBO Diploma.
10 commandments of smile esthetics
Dental esthetics. Orthodontics. Smile.
The search for esthetic treatment has persisted in the routine of dental professionals. Following this trend, dental patients have sought treatment with the primary aim of improving smile esthetics. The aim of this article is to present a protocol to assess patient's smile: The 10 Commandments of smile esthetics.