Orthodontic-surgical treatment of class III malocclusion with mandibular asymmetry

Class III skeletal malocclusion may present several etiologies, among which maxillary deficiency is the most frequent. Bone discrepancy may have an unfavorable impact on esthetics, which is frequently aggravated by the presence of accentuated facial asymmetries. This type of malocclusion is usually treated with association of Orthodontics and orthognathic surgery for correction of occlusion and facial esthetics. This report presents the treatment of a patient aged 15 years and 1 month with Class III skeletal malocclusion, having narrow maxilla, posterior open bite on the left side, anterior crossbite and unilateral posterior crossbite, accentuated negative dentoalveolar discrepancy in the maxillary arch, and maxillary and mandibular midline shift. Clinical examination also revealed maxillary hypoplasia, increased lower one third of the face, concave bone and facial profiles and facial asymmetry with mandibular deviation to the left side. The treatment was performed in three phases: presurgical orthodontic preparation, orthognathic surgery and orthodontic finishing. In reviewing the patient's final records, the major goals set at the beginning of treatment were successfully achieved, providing the patient with adequate masticatory function and pleasant facial esthetics.A maloclusão esquelética de Classe III pode apresentar diversas etiologias, sendo a deficiência maxilar a mais frequente. Discrepâncias esqueléticas podem ter impacto estético desfavorável, muitas vezes agravadas pela presença de assimetrias faciais acentuadas. Este tipo de maloclusão é geralmente tratado com a associação de Ortodontia e cirurgia ortognática para a correção da oclusão e da estética facial. Este relato de caso apresenta o tratamento de um paciente com 15 anos e 1 mês de idade, com maloclusão esquelética de Classe III, atresia maxilar, mordida aberta posterior do lado esquerdo, mordida cruzada anterior e mordida cruzada posterior unilateral, acentuada discrepância dento-alveolar negativa acentuada no arco maxilar e desvios das linhas médias superior e inferior. Ao exame clínico o paciente também apresentava deficiência maxilar, aumento do terço inferior da face, perfil ósseo e facial côncavos e assimetria facial, com desvio da mandíbula para o lado esquerdo. O tratamento foi realizado em três fases: preparo ortodôntico pré-cirúrgico, cirurgia ortognática e finalização ortodôntica. Analisando os registros finais do paciente, os principais objetivos estabelecidos ao início do tratamento foram alcançados com sucesso, promovendo ao paciente adequada função mastigatória e estética facial agradável

Microbial species associated with dental caries found in saliva and in situ after use of self-ligating and conventional brackets

Objectives: Enamel demineralization is among the main topics of interest in the orthodontic field. Self-ligating brackets have been regarded as advantageous in this aspect. The aim of this study was to evaluate the break homeostasis in the oral environment and the levels of microorganisms associated with dental caries among the different types of brackets. Material and Methods: Twenty patients received two self-ligating brackets: InOvation®R, SmartClipTM, and one conventional GeminiTM. Saliva was collected before bonding (S0), 30 (S1) and 60 (S2) days after bonding. One sample of each bracket was removed at 30 and 60 days for the in situ analysis. Checkerboard DNA-DNA Hybridization was employed to evaluate the levels of microbial species as-sociated with dental caries. Data were evaluated by nonparametric Friedman and Wilcoxon tests at 5% significance level. Results: The salivary levels of L. casei (p=0.033), S. sobrinus (p=0.011), and S. sanguinis (p=0.004) increased in S1. The in situ analyses showed alteration in S. mutans (p=0.047), whose highest levels were observed to the In-Ovation®R. Conclusions: The orthodontic appliances break the salivary homeostasis of microorganisms involved in dental caries. The contamination pattern was different between self-ligating and conventional brackets. The InOvation®R presented worse performance considering the levels of cariogenic bacterial species

Successful and failed mini-implants: microbiological evaluation and quantification of bacterial endotoxin

Objectives: Using two groups of mini-implants (successful and failed) the objectives of this in vivo study were: to evaluate the microbial contamination by the checkerboard DNA-DNA hybridization technique and to quantify the bacterial endotoxin by the limulus amebocyte lysate assay. Material and Methods:The 15 successful and 10 failed mini-implants (1.6 mm diameter × 7.0 or 9.0 mm long), placed in the maxilla and/or mandible, were obtained from 15 patients undergoing orthodontic treatment. Data were analyzed statistically by the Wilcoxon rank-sum test using the SAS software (a=0.05). Results: All 40 microbial species were detected in both groups of mini-implants, with different frequencies. No differences were observed between the groups with respect to microbial complexes (blue, purple, yellow, green, orange, red and other species) and endotoxin quantification (p>0.05). Conclusion: Neither microbial contamination nor endotoxin quantification was determinant for the early loss of stability of the mini-implant

Molecular detection of in-vivo microbial contamination of metallic orthodontic brackets by checkerboard DNA-DNA hybridization

Introduction: Knowing the microbiota that colonizes orthodontic appliances is important for planning strategies and implementing specific preventive measures during treatment. The purpose of this clinical trial was to evaluate in vivo the contamination of metallic orthodontic brackets with 40 DNA probes for different bacterial species by using the checkerboard DNA-DNA hybridization (CDDH) technique. Methods: Eighteen patients, 11 to 29 years of age having fixed orthodontic treatment, were enrolled in the study. Each subject had 2 new metallic brackets bonded to different premolars in a randomized manner. After 30 days, the brackets were removed and processed for analysis by CDDH. Data on bacterial contamination were analyzed descriptively and with the Kruskal-Wallis and Dunn post tests (a 5 0.05). Forty microbial species (cariogenic microorganisms, bacteria of the purple, yellow, green, orange complexes, "red complex 1 Treponema socranskii," and the cluster of Actinomyces) were assessed. Results: Most bacterial species were present in all subjects, except for Streptococcus constellatus, Campylobacter rectus, Tannerella forsythia, T socranskii, and Lactobacillus acidophillus (94.4%), Propionibacterium acnes I and Eubacterium nodatum (88.9%), and Treponema denticola (77.8%). Among the cariogenic microorganisms, Streptococcus mutans and Streptococcus sobrinus were found in larger numbers than L acidophillus and Lactobacillus casei (P \0.001). The periodontal pathogens of the orange complex were detected in larger numbers than those of the "red complex 1 T socranskii" (P \0.0001). Among the bacteria not associated with specific pathologies, Veillonella parvula (purple complex) was the most frequently detected strain (P \0.0001). The numbers of yellow and green complex bacteria and the cluster of Actinomyces were similar (P .0.05). Conclusions: Metallic brackets in use for 1 month were multi-colonized by several bacterial species, including cariogenic microorganisms and periodontal pathogens, reinforcing the need for meticulous oral hygiene and additional preventive measures to maintain oral health in orthodontic patients. (Am J Orthod Dentofacial Orthop 2012;141:24-9

Quantification of pro-inflammatory cytokines and osteoclastogenesis markers in successful and failed orthodontic mini-implants

Objectives: Miniscrew has been frequently used, considering that anchorage control is a critical point in orthodontic treatment, and its failure, the main adverse problem. Using two groups of stable (successful) and unstable (failed) mini-implants, this <i>in vivo</i> study aimed to quantify proinflammatory cytokines IL-1 α, IL-6, IL-17, and TNF-α and osteoclastogenesis marker RANK, RANKL, and OPG in gingival tissue, using the real-time polymerase chain reaction technique. Methodology: Thirteen patients of both sexes (11-49 years old) under orthodontic treatment were selected, obtaining 11 successful and 7 failed mini-implants. The mini-implants were placed and removed by the same surgeon, in both jaws. The mean time of permanence in the mouth was 29.4 months for successful and 7.6 months for failed mini-implants. At removal time, peri-mini-implant gingival tissue samples were collected and processed for quantification of the proinflammatory cytokines and osteoclastogenesis markers. Nonparametric Wilcoxon rank-sum test considering the clusters and Kruskal-Wallis test were used for statistical analysis (α=0.05). Results: No significant difference (p>0.05) was observed between the groups for either quantification of cytokines or osteoclastogenesis markers, except for IL-6 (p<0.05). Conclusions: It may be concluded that the expression of IL-1α, IL-17, TNF-α, RANK, RANKL, and OPG in peri-implant gingival tissue were not determinant for mini-implant stability loss, but the higher IL-6 expression could be associated with mini-implant failure

Orthodontic mini-implants: microbiological evaluation and quantification of bacterial endotoxin, proinflammatory cytokines and osteoclastogenesis markers

Os mini-implantes ortodônticos vem sendo amplamente utilizados na prática clínica como dispositivos de ancoragem. No entanto, há casos em que ocorre sua perda durante o tratamento. Inúmeros aspectos tem sido analisados com o intuito de detectar as causas do insucesso, porém estas ainda não estão totalmente esclarecidas. Portanto, utilizando-se dois grupos de mini-implantes - com estabilidade (sucesso) e sem estabilidade (falha) -, os objetivos do presente estudo in vivo foram: 1) avaliar a contaminação microbiana, empregando sondas de DNA para 40 espécies de bactérias, por meio da técnica de biologia molecular checkerboard DNA-DNA hybridization; 2) quantificar a endotoxina bacteriana presente nos mini-implantes dos dois grupos por meio do teste Limulus Amebocyte Lysate ; e 3) quantificar as citocinas pró-inflamatórias IL-1&alpha;, IL-6, IL-17 e TNF-&alpha; e proteínas marcadoras da osteoclastogênese (RANK, RANKL e OPG) por meio da técnica real-time polymerase chain reaction. Dezesseis pacientes de ambos os sexos (11-49 anos) em tratamento ortodôntico com aparelho corretivo e mini-implantes foram selecionados, sendo obtidos 19 miniimplantes com estabilidade e 10 mini-implantes sem estabilidade. O tempo médio de permanência na boca foi de 23,8 meses para os mini-implantes estáveis e 6,7 meses para os mini-implantes sem estabilidade. Foram utilizados mini-implantes da marca Neodent, com 1,6mm de diâmetro e com 7,0 ou 9,0 mm de comprimento, colocados na maxila e/ou mandíbula. Todos os mini-implantes foram instalados e removidos pelo mesmo cirurgião. No momento da remoção, foram coletados os miniimplantes e amostras de gengiva ao redor dos mesmos. Os mini-implantes foram processados para a detecção dos micro-organismos e para a quantificação da endotoxina bacteriana. As amostras de gengiva foram processadas para a quantificação das citocinas pró-inflamatórias e proteínas marcadoras da osteoclastogênese. Os resultados obtidos foram analisados por meio do teste nãoparamétrico de soma de postos de Wilcoxon, considerando-se os conglomerados, utilizando o software SAS. O nível de significância adotado foi de 5%. Todas (100%) as 40 espécies de microorganismos foram observadas em ambos os grupos de mini-implantes, com diferentes porcentagens de ocorrência. Não foi possível observar diferença entre os grupos com relação aos complexos microbianos (azul, roxo, amarelo, verde, laranja, vermelho e outras espécies). Também não foi possível observar diferença na quantificação de endotoxina e das citocinas e marcadores da osteoclastogênese (p>0,05), com exceção da IL-6 (p0.05), except for IL- 6 (p<0.05). Based on the obtained results, it may be concluded that neither the microbial contamination and amount of endotoxin in mini-implants, nor the expression of proinflammatory cytokines IL-1&alpha;, IL-17 and TNF-&alpha; and osteoclastogenesis markers RANK, RANKL and OPG in the periimplant gingival tissue acted as factors responsible for the loss of stability of the mini-implants, and that the higher expression of the IL-6 proinflammatory cytokine may be directly associated with the loss of stability of the mini-implants, suggesting additional studies

Detecção de microrganismos em bráquetes metálicos in vivo, com ou sem utilização de agente antimicrobiano, pela técnica Checkerboard DNA-DNA Hybridization

A presente Dissertação foi composta de dois estudos. O objetivo do primeiro estudo foi avaliar in vivo, por meio da técnica Checkerboard DNA-DNA Hybridization, a contaminação de bráquetes metálicos por 40 espécies diferentes de microrganismos pertencentes aos complexos amarelo, verde, laranja e vermelho, grupo dos Actinomyces e bactérias cariogênicas. Participaram do estudo 18 pacientes (11 a 29 anos), em tratamento ortodôntico, nos quais foram colados 2 bráquetes metálicos novos, em pré-molares diferentes. Decorridos 30 dias, os bráquetes foram removidos e processados pela técnica Checkerboard DNA-DNA Hybridization. Os resultados foram analisados por meio do teste não-paramétrico de Kruskal-Wallis e pós-teste de Dunn (α=5%). De acordo com os resultados obtidos, a maioria dos microrganismos estava presente em 100% dos indivíduos. Dentre os microrganismos cariogênicos, S. mutans e S. sobrinus foram encontrados em maiores quantidades que L. acidophillus e L. casei (p0,05). O objetivo do segundo estudo foi avaliar, in vivo, por meio da técnica Checkerboard DNA-DNA Hybridization, a contaminação de bráquetes metálicos por 17 espécies de microrganismos periodontopatogênicos dos complexos vermelho e laranja e a eficácia do gluconato de clorexidina a 0,12% (Periogard®), sob a forma de bochechos. Participaram do estudo 39 pacientes (11 a 33 anos), em tratamento ortodôntico, nos quais foram colados 2 bráquetes...The present Master’s degree thesis was composed of two studies. The purpose of the first study was to evaluate in vivo by the Checkerboard DNA-DNA Hybridization technique the contamination of metallic orthodontic brackets by 40 microbial species of the yellow, green, orange and red complexes, Actinomyces group and cariogenic bacteria. Eighteen patients aged 11 to 29 years under orthodontic treatment were enrolled in this study and all subjects had 2 new metallic brackets bonded to different premolars in a randomized manner. After 30 days, the brackets were removed and processed for analysis by Checkerboard DNA-DNA Hybridization. The data were analyzed statistically by the non-parametric Kruskal-Wallis and Dunn’s post tests (α=5%). According to the obtained results, most evaluated microorganisms were present in 100% of the individuals. Among the cariogenic microorganisms, S. mutans and S. sobrinus were found in larger numbers than L. acidophillus and L. casei. (p0.05). The purpose of the second study was to evaluate in vivo by the Checkerboard DNA-DNA Hybridization technique the contamination of metallic orthodontic brackets by 17 periodontopathogenic microorganisms of the red and orange complexes, and the efficacy of 0.12% chlorhexidine gluconate (Periogard®) mouthwashes against these microbial strains. Thirty-nine patients aged 11 to 33 years under orthodontic treatment were enrolled in this study and all subjects had 2 new metallic brackets... (Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Influence of resin-modified glass ionomer and topical fluoride on levels of Streptococcus mutans in saliva and biofilm adjacent to metallic brackets

Decalcification of enamel during fixed orthodontic appliance treatment remains a problem. White spot lesions are observed in nearly 50% of patients undergoing orthodontic treatment. The use of fluoride-containing orthodontic materials has shown inconclusive results on their ability to reduce decalcification. The aims of this investigation were to compare the levels of Streptococcus mutans (SM) in saliva and biofilm adjacent to orthodontic brackets retained with a resin-modified glass ionomer cement (RMGIC) (Fuji ORTHO LC) and a light cured composite resin (Transbond XT), and to analyze the influence of topical application of the 1.23% acidulated phosphate fluoride (APF) on SM counts. In a parallel study design, two groups (n=14/15) were used with random allocation and high salivary SM counts before treatment. Biofilm was collected from areas adjacent to the brackets on teeth 13, 22, 33, and 41. Both saliva and biofilm were collected on the 7th, 21st, 35th, and 49th days after appliance placement. Topical fluoride application was carried out on the 35th day. Bonding with RMGIC did not alter SM counts in saliva or biofilm adjacent to the brackets. On the other hand, the biofilm adjacent to brackets retained with composite resin showed a significant increase in SM counts along the trial period. Topical application of 1.23% APF did not reduce salivary or biofilm SM counts regardless of the bonding material. In conclusion, fluoride topical application did not show efficacy in reducing SM. The use of RMGIC as bonding materials allowed a better control of SM cfu counts in dental biofilm hindering the significant increase of these microorganisms along the trial period, which was observed in the biofilm adjacent to the composite material