The Dilemma of the Open Gingival Embrasure Between Maxillary Central Incisors

Aim: The aim of this report is to present the etiology, diagnosis, and treatment planning strategy in the presence of an open gingival embrasure between the maxillary central incisors. Background: The open gingival embrasure or “black triangle” is a visible triangular space in the cervical region of the maxillary incisors. It appears when the gingival papilla does not completely fill in the interdental space. The space may occur due to: (1) disease or surgery with periodontal attachment loss resulting in gingival recession; (2) severely malaligned maxillary incisors; (3) divergent roots; or (4) triangular-shaped crowns associated with or without periodontal problems and alveolar bone resorptions. Report: The post-treatment prevalence in adult orthodontic patients is estimated to be around 40% compromising the esthetic result. Conclusion: Several methods of managing patients with open gingival embrasure exist, but the interdisciplinary aspects of treatment must be emphasized to achieve the best possible result. The orthodontist can play a significant role in helping to manage these cases

Propriedades mecânicas de fios ortodônticos em bráquetes cerâmicos associados com ligaduras de baixa fricção

Introduction: Few studies investigated the mechanical properties of orthodontic wires on ceramic brackets associated the ligatures. Objective: This study aimed to compare the load-deflection of orthodontic wires with round section of 0.016” made of stainless steel (SS), nickel-titanium (NiTi) and glass fiber-reinforced polymer composite (GFRPC). Material and method: Sixty specimens obtained from 10 sectioned pre-contoured arches (TP Orthodontics), were divided into 3 groups of 20 according to each type of material (1 esthetic-type wire and 2 not esthetic) and length of 50 mm. The methodology consisted of a 3-point bending test using esthetic ceramic brackets (INVU, TP Orthodontics, Edgewise, 0.022”x 0.025”) as points of support. The tensile tests were performed on a mechanical test machine, at a speed of 10 mm/min, deflection of 1 mm, 2 mm and 3 mm. Friedman’s Non Parametric Multiple comparisons test was used (P<0.05). Result: The nickel-titanium wire presented smaller load/ deflection compared with stainless steel. GFRPC wires had lower strength values among all groups evaluated (P<.05). The steel wire showed permanent deformation after 3 mm deflection, NiTi wire demonstrated memory effect and the esthetic type had fractures with loss of strength. Conclusion: It can be concluded that steel wires have high strength values, requiring the incorporation of loops and folds to reduce the load / deflection. NiTi and GFRPC wires produced low levels of force, however the esthetic wire was shown to fracture and break.Introdução: Poucos estudos investigaram as propriedades mecânicas dos fios ortodônticos em bráquetes cerâmicos associados às ligaduras. Objetivo: O objetivo deste estudo foi comparar a carga-deflexão de fios ortodônticos com seção redonda de 0,016” de aço inoxidável (AI), níquel-titânio (NiTi) e composto de polímero reforçado com fibra de vidro (CPRFV). Material e método: Sessenta espécimes obtidos a partir de 10 arcos pré-contornos seccionados (TP Orthodontics), foram divididos em 3 grupos de 20 de acordo com cada tipo de material (1 fio estético e 2 não estético) e comprimento de 50 mm. A metodologia consistiu de um teste de flexão de 3 pontos usando bráquetes estéticos cerâmicos (INVU, TP Orthodontics, Edgewise, 0,022 “x 0,025”) como pontos de suporte. Os ensaios de tração foram realizados em uma máquina de ensaios mecânicos, a uma velocidade de 10 mm / min, deflexão de 1 mm, 2 mm e 3 mm. Utilizou-se o teste não-paramétrico de comparações múltiplas de Friedman (P <0,05). Resultado: O fio de níquel-titânio apresentou menor carga / deflexão em relação ao aço inoxidável. Os fios CPRFV tiveram valores de resistência mais baixos entre todos os grupos avaliados (P <0,05). O fio de aço mostrou deformação permanente após deflexão de 3 mm, fio NiTi demonstrou efeito de memória e o tipo estético teve fraturas com perda de força. Conclusão: Pode-se concluir que os fios de aço têm valores de resistência elevados, exigindo a incorporação de alças e dobras para reduzir a carga / deflexão. Os fios NiTi e CPRFV produziram baixos níveis de força, porém o fio estético mostrou-se fraturado e quebrado

Facial and dental alterations according to the breathing pattern

There is controversy in the literature about possible interaction of the respiratory mode with the facial and dental structures. OBJECTIVES: The aim of this study was to perform a longitudinal assessment of the changes in facial and dental structures in Angle's Class II, division 1 malocclusion individuals, divided according to the respiratory pattern (predominantly nasal or mouth), at two distinct moments of craniofacial development. MATERIAL AND METHODS: Pogonium and nose measurements were made on the lateral cephalometric tracings (LS'-Pog', LS'-B', B'-Pog', Pog'-PogTeg', Line NB, Pog-NB, N'-Prn, Prn-NPog, N-Prn-Sn, Prn-Sn-LS). Dental measurements were made on the plaster models (distances between the tips of the canine cusps and the tips of mesial cusps of the first molars) of 40 individuals aged 10 to 14 years (moment 1) and 13 to 16 years (moment 2), 23 being nose breathers (NB) and 17 being predominantly mouth breathers (MB). RESULTS: The Student's-t test and two-way ANOVA with repeated measures were applied to indicate differences between the mean values of these variables according to the moments and/or respiratory mode. CONCLUSIONS: There were alterations in the facial measurements, without interference of the breathing pattern. However, the breathing pattern infuenced dental alterations

Smile Arc Esthetics in Middle-Aged Man from the Layperson’s Perspective Via Eye-Tracking

Objective:&nbsp;To evaluate the perceptions of smile esthetics associated with variations in the vertical plane of the maxillary incisors in the smile arc using eye-tracking software.&nbsp;Material and Methods:&nbsp;An image of a 59-year-old Caucasian male model was adapted and edited to make three changes in the vertical plane, simulating a convex, straight, and reverse smile arc. Four areas of interest were inserted at the right and left eyes, nose, and mouth. Forty laypeople raters between 18 and 45 years of age participated of the study. Eye-tribe hardware and Ogama software were used to perform eye-tracking. Attractiveness and age-perception questions were also incorporated into the study. ANOVA test and Pearson’s correlation coefficient, at p &lt; 0.05.&nbsp;Results:&nbsp;The most observed AOI in images with convex, straight, and reverse smiles, as assessed using heatmaps and point maps, was the mouth, followed by the right eye. A significant difference for the eye (p=0.02) was found when comparing convex and reverse smiles, whereas a significant difference for the mouth was observed between the straight and reverse smiles (p=0.03).&nbsp;Conclusion:&nbsp;Convex and straight smile arcs were associated with equal levels of attractiveness; the reverse smile was less attractive. No significant difference was noticed regarding age perception and the smile arcs. However, the reverse smile recorded a more complete fixation time

Influence of different beverages on the force degradation of intermaxillary elastics: an in vitro study

Objective: The aim of this study was to evaluate in vitro the effects of frequently ingested beverages on force degradation of intermaxillary elastics. Material and Methods: One hundred and eighty 1/4-inch intermaxillary elastics (TP Orthodontics) were immersed into six different beverages: (1) Coca-Cola®; (2) Beer; (3) Orange juice; (4) Red wine; (5) Coffee and (6) artificial saliva (control). The period of immersion was 15 min for the first and second cycles and 30 min for the third to fifth cycles. Tensile forces were read in a tensile testing machine before and after the five immersion cycles. One-way repeated measures ANOVA was used to identify significant differences. Results: Force degradation was seen in all evaluated groups and at all observation periods (

Invisalign Therapy in a Case of Mandibular Incisor Extraction

Clear aligners have been sought by patients as an aesthetic alternative to conventional orthodontic treatment. Despite the limitation that the aligner system offers, its use has improved over time. Hereby, authors discusses case of a 35-year-old female with Angle’s Class I malocclusion patient with severe mandibular crowding who was treated with mandibular incisor extraction using the Invisalign system. Clinical and radiographic examination revealed skeletal Class I malocclusion, severe crowding of the lower incisors, light crowding of the upper incisors, crossbite of the mandibular right canine, a convex profile, prominent lower lip, and a Bolton discrepancy in the lower anterior region. Fourteen trays were used in the maxillary arch and 28 in the mandibular arch. Two additional refinements, one with 13 and the other with 10 trays were delivered. After 2 years and 2 months of active treatment, good posterior occlusion and alignment of the teeth with adequate occlusion function and a balanced smile were achieved. The maxillary retainer was used continuously for 1 year, and at night until now. Successful tooth alignment and space closure were maintained, and the patient was satisfied with the results on the 2 year follow-up

Impact of the COVID-19 pandemic on facial pain, anxiety, depression, quality of life, and awake bruxism in sleep bruxism patients, occlusal splint users

Introduction: The COVID-19 pandemic may lead to increased risk of developing or worsening bruxism and facial pain. Objective: To evaluate the influence of pandemic on adults with Sleep Bruxism (BS), both sexes, rigid occlusal splint users. Methods: Longitudinal observational study conducted in adults, both sexes, with Possible BS (n= 50), mean age 35.95 ± 10.35 years, before (T1) and during (T2) COVID-19 pandemic, in person and remotely, respectively. Presence and intensity of pain (Visual Analog Scale) in the masseter and temporal muscles and temporomandibular joint (TMJ) region, anxiety and depression (HADS), quality of life (QoL) (WHOQOL - Brief) and Awake Bruxism (AB) were assessed. Student's t- test, Mann-Whitney U-test, Wilcoxon, Pearson's chi-square and Mc-Nemar tests were applied (p&lt;0.05). Results: The frequency of subjects with masseter, temporal and TMJ pain was 72%, 22%, 42% at T1 and 44%, 26%, 60% at T2, respectively; AB was 78% at T1 and 70% at T2. At both times pain intensity was moderate, there was absence of anxiety and depression, and QoL was regular. At T2, the frequency of subjects with masseter pain decreased 28%, domains physical, psychological and QoL mean&nbsp;worsened (p&lt;0.05). The other variables showed no difference between times (p&gt;0.05). Conclusions: During the COVID-19 pandemic, the use of rigid occlusal splints&nbsp;contributed to pain control in masseter muscle; anxiety and depression were absent, QoL worsened, and AB frequency remained high.Introduction: The COVID-19 pandemic may lead to increased risk of developing or worsening bruxism and facial pain. Objective: To evaluate the influence of pandemic on adults with Sleep Bruxism (BS), both sexes, rigid occlusal splint users. Methods: Longitudinal observational study conducted in adults, both sexes, with Possible BS (n= 50), mean age 35.95 ± 10.35 years, before (T1) and during (T2) COVID-19 pandemic, in person and remotely, respectively. Presence and intensity of pain (Visual Analog Scale) in the masseter and temporal muscles and temporomandibular joint (TMJ) region, anxiety and depression (HADS), quality of life (QoL) (WHOQOL - Brief) and Awake Bruxism (AB) were assessed. Student's t- test, Mann-Whitney U-test, Wilcoxon, Pearson's chi-square and Mc-Nemar tests were applied (p&lt;0.05). Results: The frequency of subjects with masseter, temporal and TMJ pain was 72%, 22%, 42% at T1 and 44%, 26%, 60% at T2, respectively; AB was 78% at T1 and 70% at T2. At both times pain intensity was moderate, there was absence of anxiety and depression, and QoL was regular. At T2, the frequency of subjects with masseter pain decreased 28%, domains physical, psychological and QoL mean worsened (p&lt;0.05). The other variables showed no difference between times (p&gt;0.05). Conclusions: During the COVID-19 pandemic, the use of rigid occlusal splints contributed to pain control in masseter muscle; anxiety and depression were absent, QoL worsened, and AB frequency remained high