Can rapid maxillary expansion affect speech sound production in growing patients? A systematic review

Rapid maxillary expansion (RME) may change speech sound parameters due to the enlargement of oral and nasal cavities. This study aimed to systematically review the current evidence on speech changes as a side effect of RME. An electronic search was conducted in nine databases, and two of them accessed the 'grey literature'. The eligibility criteria included clinical studies assessing orthodontic patients with maxillary transverse deficiency and the relationship with speech alterations without restricting publication year or language. Only interventional studies were included. The JBI Critical Appraisal Tool assessed the risk of bias. The initial search provided 4853 studies. Seven articles (n = 200 patients) met the inclusion criteria and were analysed. The primary source of bias was the absence of a control group in four studies. RME altered speech production by changing vowel fundamental frequency and fricative phoneme formant frequency. Shimmer and jitter rates changed in one and two studies, respectively. Two studies presented deterioration during orthodontic treatment, but speech improved after appliance removal. Despite the limited evidence, RME affects speech during and after treatment.

Development and psychometric properties of a questionnaire about knowledge of lay people about traumatic dental injury

BACKGROUND/AIMS

The level of knowledge about traumatic dental injuries (TDI) of lay people from a national point of view has never been studied and there is currently a lack of validated research instruments on this issue. The present study aims to develop and validate a questionnaire (TDI-Q) to assess the knowledge of lay people about TDI, including participants from the five regions of Brazil.

MATERIAL AND METHODS

TDI-Q was drafted, in Brazilian Portuguese, based on the recommendations of the International Association of Dental Traumatology (IADT). Before its application, TDI-Q was evaluated by dentists, lay people, linguists, and psychometrists. The questionnaire was applied to measure temporal stability at two distinct times, with an interval of 15-20 days between the two applications: test (n = 110) and retest (n = 50). The presence of floor and ceiling effects were investigated by analyzing the frequency of responses of the questionnaire; convergent construct validity was tested through Spearman's correlation; the Mann-Whitney test was applied to discriminant construct validity. Temporal stability and internal consistency were evaluated through intraclass correlation coefficient and Cronbach's alpha, respectively.

RESULTS

The floor and ceiling effects were not observed (0.9% and 2.7%, respectively); convergent validity analysis indicated a positive and strong correlation (r = 0.50; p < .001). Significant discriminant construct validity (p < .05) was observed. Satisfactory internal consistency (α = 0.7) and temporal stability (ICC = 0.82, p < .001) were also achieved.

CONCLUSION

TDI-Q proved to have good psychometric properties and to be a reliable tool for evaluating the knowledge of lay people regarding TDI in the Brazilian population.

Changes in biomarkers levels from gingival crevicular fluid in pre- and postmenopausal women undergoing orthodontic treatment : A systematic review

PURPOSE

This study aimed to verify whether there is a difference in biomarker levels in the gingival crevicular fluid between premenopausal and postmenopausal women undergoing orthodontic treatment.

METHODS

As eligibility criteria, prospective or retrospective observational studies evaluating women undergoing orthodontic treatment (P), comparing postmenopausal (E) and premenopausal (C) women, and analyzing differences in gingival crevicular fluid biomarkers (O) were included. An electronic search was conducted in seven databases (PubMed, Scopus, Web of Science, LILACS, The Cochrane Library, Embase, and EBSCO: Dentistry & Oral Science) and one grey literature source (Google Scholar). All databases were searched from September 2022 to March 2023. After duplicate exclusion and data extraction, the Newcastle-Ottawa scale was applied to assess the quality and risk of bias, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to verify the certainty of evidence.

RESULTS

Three case-control studies that analyzed receptor activator of nuclear factor kappa‑B ligand (RANKL), osteopontin (OPN), and interleukin (IL)-17A levels were included. One study reported a significant difference for RANKL and another for OPN levels. A third study reported that there was a higher expression of IL17‑A in the postmenopausal group. However, the small number of articles limits our systematic review. The heterogeneity and imprecision in the study results cast doubt on the findings' internal validity.

CONCLUSION

The studies reported alterations in biomarker levels but differed in their conclusions. Therefore, further studies must include other types of bone and inflammatory biomarkers in female patients who are pre- or postmenopausal and undergoing orthodontic treatment.

REGISTRATION

The review was registered at the Open Science Framework ( https://doi.org/10.17605/OSF.IO/Q9YZ8 ).

Occlusion development after premature loss of deciduous anterior teeth: preliminary results of a 24-month prospective cohort study

OBJECTIVE

This study aimed to evaluate occlusion development after premature loss or extraction of deciduous anterior teeth, by means of a prospective cohort study.

METHODS

Fifteen infants and children aged 1 to 5 years old were longitudinally assessed (with loss or extraction of deciduous anterior teeth [n = 9], and without tooth losses [n = 6]). Photographs and dental casts at the baseline and after 24 months of follow-up were performed. Dental casts were scanned, and linear measurements were made on the digitalized models (missing tooth space, arch perimeter, arch length, arch width, intercanine length and intercanine width). The t-test was used for groups comparisons (α = 0.05).

RESULTS

Individuals' mean age at baseline was 2.93 (± 1.18) years. No statistically significant differences were observed in the missing tooth space in the group with tooth loss during the 24 months of follow-up (p > 0.05). Arch perimeter, arch length, arch width, intercanine length and intercanine width did not show differences between the groups (p > 0.05). Qualitative photographic evaluation revealed other changes in the dental arches and occlusion, such as exfoliation and eruption of deciduous teeth, eruption of permanent teeth, self-correction or establishment of malocclusion, among others.

CONCLUSION

The results suggest that the premature loss of deciduous anterior teeth does not affect the perimeter, length and width of the dental arches; however, other alterations that lead to malocclusion could be established.

Brazilian dentist's knowledge of minimum intervention dentistry for caries management: application of a developed knowledge scale (MIDDeC-KS) and evaluation of its psychometric properties

AIM

To assess the knowledge of Brazilian dentists about Minimum Intervention (MI) using a Minimum Intervention Dentistry to Dental Caries-Knowledge Scale (MIDDeC-KS) and evaluate its psychometric properties.

MATERIALS AND METHODS

An online scale was developed to evaluate dentists' knowledge about MI. The higher the score, the greater the knowledge and vice versa. A preliminary study was carried out with 143 dentists to validate the MIDDeC-KS. For psychometric properties analysis, convergent and discriminant validity, test-retest reliability, and internal consistency of the instrument were assessed. After validation, MIDDeC-KS was applied to a representative sample of Brazilian dentists. T test for independent samples, Chi-square, and/or ANOVA one-way tests were applied.

RESULTS

The MIDDeC-KS convergent (Spearman's = 0.48) and discriminant (P = 0.001) validity and reliability (ICC = 0.85, α = 0.72 and ω = 0.74) were proved. The participants (n = 637) obtained an overall mean score of 7.4 ± 2.5. The sample was mainly composed of females (P < 0.01), who graduated over 10 years prior (P = 0.02), from public colleges (P < 0.01), and most were pediatric dentists (38.2%). The highest and lowest scores were reached by pediatric dentists (9.2 ± 1.6) and bucomaxillofacial professionals (3.1 ± 2.1), respectively. Brazilian dentists demonstrated more knowledge about diet, biofilm, and topical fluoride control (84.3%), while the Hall technique (31.9%), resin infiltrant (47.6%), and chemical mechanical caries removal (48.4%) were the least known MI techniques.

CONCLUSION

Brazilian dentists demonstrated more knowledge about preventive measures and less about more recent protocols, such as the Hall technique, resin infiltrant, and chemical mechanical caries tissue removal. Sufficient psychometric evidence of the MIDDeC-KS was found.

CLINICAL RELEVANCE

Identify dentist's knowledge about MI.

Peeling with retinoic acid in microemulsion for treatment of melasma: A double-blind randomized controlled clinical study

OBJECTIVE

To evaluate the clinical efficacy of peeling with a microemulsion formulation containing 1% retinoic acid.

MATERIALS AND METHODS

After development of the product, 60 patients with melasma were randomly divided into three groups (n = 20): Group 1-application of conventional 1% retinoic acid peeling (RA 1%). Group 2-application of 1% retinoic acid peeling in microemulsion (RA 1%M). Group 3-Application of placebo. The groups were submitted to four peeling sessions, fortnightly on Days 0, 15, 30, and 45, and analyzed at the time intervals of 0, 15, 30, 45, and 60 days. Evaluation was made by using the Melasma Area and Severity Index (MASI) and Melasma Quality of Life (MelasquoL) instrument. Hemato-biochemical parameters were also evaluated at Days 0 and 60. After obtaining the results, normality was evaluated by means of the Kolmogorov-Smirnov test and afterwards, the following tests were applied: Friedman statistical (to test the effect of the treatments on the MASI index); Wilcoxon, (for comparison between pairs to test the effect of treatments on the MelasQoL index); Kruskal-Wallis, (to test the differences between the groups); and Mann-Whitney, (comparisons between treatments). The level of significance adopted was 5% (α = 0.05).

RESULTS

The three groups presented a significant reduction in the MASI index, indicating the effect of all the treatments on reducing the melasma (p < 0.001). A significant reduction in the stains was observed with the use of retinoic acid peeling delivered in microemulsion (62%) when compared with the conventional peeling with 1% retinoic acid in a conventional vehicle (26%) and the placebo (12%). There was also a significant reduction in the MelasQoL index (sum of all the aspects) in the three groups, indicating the effect of all the treatments, including the placebo, on the overall quality of life of those with melasma. However, RA 1%M the treatment that promoted the greatest effect on the quality of life of individuals. In percentage terms, the RA 1%M provided a mean reduction of 30% in the MelasQoL index, against 13% of the conventional treatment and only 4% of the placebo. When the hemato-biochemical parameters were compared on Days 0 and 60, there were no significant changes in the results.

CONCLUSION

The chemical peeling performed with RA 1%M was effective for the treatment of melasma, and was shown to be superior to the peeling performed with retinoic acid in a conventional vehicle, in reducing the stains and improving the quality of life of patients.

In-vitro effect of a single application of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets

OBJECTIVE

To assess the in-vitro effect of single applications of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets.

MATERIAL AND METHODS

Tooth/bracket sets (n=65) were immersed in artificial saliva (1h at 37ºC) and randomly subjected to single applications (100µL; 1min) of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP emulsion), CPP-ACP with fluoride (CPP-ACPF emulsion), solutions of titanium tetrafluoride (TiF4) or sodium fluoride (NaF), or no treatment (CG). Multispecies biofilm (5 x 105 CFU/mL) was formed in the presence of 2% sucrose. After 24 h, the pH and the concentration of total soluble fluoride (TSF) were analyzed by culture medium. The presence of active white spot lesions (WSL) evaluated by macroscopic examination and the percent surface mineral loss (%SML) were analyzed. Also, the topography of enamel was detected by analysis of scanning electron microscopy (SEM). The data was assessed by chi-square, Kruskal-Wallis, and Mann-Whitney tests (p < 0.05).

RESULTS

Fluoride-containing compounds led to a smaller pH reduction than did CPP-ACP and CG (p<0.05). There was difference in TSF between the groups (p<0.05), denoted as TiF4> NaF > CPP-ACPF > CPP-ACP > CG. Regarding the presence of WSL and %SML, the NaF group obtained lower values (p<0.05), while TiF4 and CPP-ACPF were similar (p>0.05). SEM demonstrated that fluoride-free groups had a larger surface dissolution.

CONCLUSION

Fluoridated groups including solutions and CPP-ACPF were more effective than CPP-ACP in reducing enamel demineralization around orthodontic brackets after a single application.

Evaluation of the impact of orthodontists' smile with malocclusions on social media and professional credibility

OBJECTIVES

This study assessed laypeople's perceptions of orthodontist credibility based on malocclusions and whether these views affect their choice to seek treatment. Eye-tracking technology and questionnaires were utilized.

MATERIALS AND METHODS

Ninety-five lay raters, through eye tracking and a questionnaire, assessed 12 images of orthodontists with malocclusions. Malocclusions were categorized by the Index Of Treatment Need (IOTN) as grade 1 (near ideal), 3 (anterior crowding), and 5 (with diastemas). Fixation points were recorded, and credibility was gauged via questionnaires. A Mentimeter word cloud was generated.

RESULTS

IOTN 1 orthodontists were viewed as more credible than IOTN 3 (p < 0.001) and 5 (p < 0.001). Raters were more willing to receive treatment from IOTN 1 orthodontists. The focus for IOTN 1 was between eyes and mouth, while IOTN 3 and 5 were on the mouth. "Crooked teeth" and "spacing" were predominant in word clouds for IOTN 3 and 5.

CONCLUSION

Orthodontists with an IOTN grade 1 rating were perceived as more competent, reliable, and professional, thus making it more likely for laypeople to choose them as their preferred providers.

CLINICAL RELEVANCE

The smiles of professionals play a significant role in laypeople's decision to choose them as their orthodontist, and strategic utilization of social media can effectively deliver health information to a larger audience in a faster and more direct manner.

Assessing the reliability of ChatGPT: a content analysis of self-generated and self-answered questions on clear aligners, TADs and digital imaging

INTRODUCTION

Artificial Intelligence (AI) is a tool that is already part of our reality, and this is an opportunity to understand how it can be useful in interacting with patients and providing valuable information about orthodontics.

OBJECTIVE

This study evaluated the accuracy of ChatGPT in providing accurate and quality information to answer questions on Clear aligners, Temporary anchorage devices and Digital imaging in orthodontics.

METHODS

forty-five questions and answers were generated by the ChatGPT 4.0, and analyzed separately by five orthodontists. The evaluators independently rated the quality of information provided on a Likert scale, in which higher scores indicated greater quality of information (1 = very poor; 2 = poor; 3 = acceptable; 4 = good; 5 = very good). The Kruskal-Wallis H test (p< 0.05) and post-hoc pairwise comparisons with the Bonferroni correction were performed.

RESULTS

From the 225 evaluations of the five different evaluators, 11 (4.9%) were considered as very poor, 4 (1.8%) as poor, and 15 (6.7%) as acceptable. The majority were considered as good [34 (15,1%)] and very good [161 (71.6%)]. Regarding evaluators' scores, a slight agreement was perceived, with Fleiss's Kappa equal to 0.004.

CONCLUSIONS

ChatGPT has proven effective in providing quality answers related to clear aligners, temporary anchorage devices, and digital imaging within the context of interest of orthodontics.

Assessment of the reliability of YouTube™ videos about zirconia crowns in pediatric dentistry

PURPOSE

To evaluate the reliability of YouTube™ videos on zirconia crowns in pediatric dentistry.

METHODS

On January 4, 2022, a search was performed using the term "pediatric zirconia crown". The first 100 videos on the subject were included. Non-English videos, duplicates, and off-topic videos were excluded. For each video, an examiner recorded the number of views, likes, comments, channel followers, upload date, duration, and category rating. Two examiners assessed the reliability of the information presented in the videos using DISCERN, a brief questionnaire and scale score used to assess in a valid and reliable way the quality of information on treatment choices for health problems. Descriptive and inferential analyses were performed (p < 0.05).

RESULTS

Of the initial 100 videos, 72 were excluded because of language, duplication, and subject matter. The 28 remaining videos had an average of 3.5 comments, 8,896.18 channel followers, 5,614.00 views, 19.14 likes, and a duration of 840.32 s. The average view rate was 7.54 per day ± 10,206.81. There was a statistically significant difference between the number of views and comments (p < 0.001), likes and comments (p < 0.001), and likes and views (p = 0.006). According to the DISCERN, none of the videos received the maximum grade to be considered very good. Two were considered good, nine fair, fourteen poor, and three very poor.

CONCLUSION

Given that the majority of YouTube™ videos currently available on zirconia crowns in pediatric dentistry were deemed unreliable according to the DISCERN questionnaire, caution should be exercised when using the information presented.

Orthodontics social media, perceptions of science- and non-science-based posts among orthodontists, dentists, students and laypeople

Worldwide, social media is gaining popularity year after year. In Brazil, by 2027, there will be more than 188 million users of social media sites, against 165 million in 2022, therefore, the usage of general population and health care professionals, including orthodontists, is increasing. Differently from scientific journals that undergo a rigorous peer review process prior to publication, the same level of demand is not found on social media. Hence, this study aimed to assess whether orthodontists can recognize scientifically based and non-science-based posts and if their perceptions are different from general opinion (laypeople), dentistry students, and dentists (non-orthodontists). The posts were created using the search tool on Instagram with the hashtags #clearaligners #acceledent #selfligatingbraces and #propelorthodontics, four scientific based posts and four without or with low scientific evidence were selected and evaluated through a virtual questionnaire in the QUALTRICS platform by 385 people, (175 laypeople, 102 dentists, 58 dentistry students, and 50 orthodontists) using a visual analogue scale (VAS). In addition, four questions were asked. ANOVA (Adjusted Bonferroni correction) and Pearson's chi-squared, and Student T tests were applied to identify statistical differences. Significant difference was found only for posts with no scientific evidence between orthodontist's group when comparing with laypeople (p < 0.001) for the #selfligatingbraces, and the #propelorthodontics for the group orthodontists when compared with laypeople (p = 0.031) and dentists (p = 0.033). Instagram was the favorite social media where most of the participants spend more than 3 h. Of the participants, 97% used social media to keep informed and read the news. Almost half of the respondents search for orthodontics services on social media. Orthodontists were able to perceive differences in only two posts from the general perception (laypeople) regarding non- or low-scientific-evidence posts.

Development and validation of the Brazilian Version of Lay Persons' Social Judgements about Cleft-lip Scale (B-LSojCleft-S)

The aim of this study was to develop and analyze the psychometric properties of the Brazilian Version of Lay Person's Social Judgement about Cleft-lip Scale (B-LSojCleft-S). A standardized photograph of a 16-year-old girl was manipulated by using photo editing software, to simulate different cleft-lip situations. The cleft-free image was used as a control. The researchers structured an initial questionnaire that was evaluated by experts and a sample of the target population to evaluate the construct. After analysis by the researchers, a final version of the B-LSojCleft-S containing 14 items was generated. Each answer was awarded score from 1 to 3 points, yielding a total score of 14 to 42 points. Higher scores represented better social judgements. The B-LSojCleft-S was applied online to 103 test participants and 73 retest participants with an interval of 20 days between application. Aspects of acceptability, discriminant property, internal consistency, reliability and construct validity were evaluated. Construct validity was assessed using the Friedman test (p < 0.05). Reliability was determined using an intraclass correlation coefficient > 0.70, and internal consistency using Cronbach's alpha > 0.81. The B-LSojCleft-S showed high acceptability, strong discriminant property, excellent internal consistency and reliability, but had a floor and ceiling effect. The instrument reached valid and reliable scores and had acceptable psychometric properties to evaluate the social judgments of lay persons about different cleft lip situations in a Brazilian population.

Treatment of Class II malocclusion with anterior open bite and posterior crossbite with the aid of mini-implants in a patient with Down syndrome: Clinical case report

OBJECTIVE

We report the orthodontic treatment of a class II malocclusion with anterior open bite and posterior crossbite in a patient with Down syndrome (DS) treated with mini-implants.

METHODS

Treatment began with rapid maxillary expansion with a Haas appliance, followed by dental alignment and leveling with a fixed appliance and the correction of class II dental relationships with the use of orthodontic mini-implants associated with a sliding jig.

RESULTS

The results obtained at the end of the treatment were satisfactory, with improvements in occlusion, including bite closure; maxillary expansion; and the correction of dental relationships.

CONCLUSION

When well-planned, orthodontic treatment in a patient with DS achieves satisfactory results from a skeletal, occlusal, and facial perspective.

Cone-beam computed tomography study of mandibular morphology and tooth compensation in asymmetrical patients

INTRODUCTION

This study evaluated mandibular morphology and transverse dental compensation between symmetrical and asymmetrical subjects, allocated according to sagittal skeletal patterns. In addition, the hypothesis that mandibular morphology and dental compensations differed between symmetrical/asymmetrical groups and also among the different types of sagittal skeletal patterns was tested.

METHODS

Cone-beam computed tomography images of 96 patients were included in this study and were divided into 2 groups according to the degree of menton deviation: a symmetrical group with deviation up to 2.0 mm (n = 48; mean age, 15 ± 6 years), and an asymmetrical group with deviation from 3.5 mm (n = 48; mean age, 16 ± 8 years). The 2 groups were divided in accordance with the ANB angle: Class I, II, and III. Skeletal and dental measurements were performed. Intergroup and intragroup analyses were carried out, using a 2-way analysis of variance to assess the interaction of factors: symmetry and sagittal skeletal pattern; and the Student t test for differences between deviated (Dv) and nondeviated (NDv) sides.

RESULTS

Symmetrical/asymmetrical groups and Class I, II, and III groups were similar in relation to demographic aspects (P = 0.412 and P = 0.357 for sex and age, respectively). Asymmetrical patients had higher values for body length and mandibular ramus and condyle height on the NDv side (P = 0.011, P = 0.024, and P = 0.001, respectively). When comparing the different skeletal patterns, patients with a Class III relationship demonstrated higher values for mandibular ramus height. Intergroup analysis showed no differences in dental parameters. In the comparison between the sides, the asymmetrical group showed a significant difference in canine inclination (P = 0.008), mandibular ramus height (P = 0.004), condyle height (P = 0.010) and gonion to midsagittal plane distance (P = 0.018).

CONCLUSIONS

Asymmetrical subjects showed higher values for canine inclination and mandibular body, ramus and condylar height on the NDv side. The hypothesis was partially confirmed that mandibular morphology and dental compensations are different between symmetrical/asymmetrical groups and among different sagittal skeletal patterns.

Predictors of perceived stress and quality of life amongst dental master and doctoral students

OBJECTIVES

This study aimed to identify predictors of perceived stress and quality of life (QoL) amongst dental master and doctoral students.

MATERIALS AND METHODS

This is a cross-sectional study with Brazilian students as participants (n = 707). The following instruments were administered: Perceived stress scale (PSS), the WHOQOL-BREF and a socio-demographic questionnaire. A linear regression model was estimated.

RESULTS

The results showed that female was associated with higher scores of PSS and lower scores of QoL. A negative correlation was observed between PSS and all four domains of QoL. Multivariate analysis revealed that the set of selected variables partially explained the variability of PSS score (28%) and the four QoL domains: physical (52%), psychological (62%), social relationships (25%) and environment (37%). The variable number of children, hours of sleep, concurrent work and study, leisure time and physical activity practice were associated with positive changes on QoL, whilst PSS and medication intake with negative. Lower PSS score was associated with the variables age, hours of sleep, leisure time and physical activity.

CONCLUSIONS

Our findings suggest that perceived stress and medication intake due to study are important predictors of lower QoL in dental master and doctoral students, especially in the psychological domain. More hours of sleep, leisure time and physical activity improved both QoL and perceived stress scores and might be feasible coping strategies for these outcomes in this population.

Patient perception of orthodontists with different stereotypes: development, psychometric properties, and application of an assessment instrument

INTRODUCTION

This research aimed to develop and validate a questionnaire that considers social judgments and, through its application, assesses whether the presence of piercings, tattoos, beards, and loose hair visible in the face and neck region reflect on the patient perception regarding characteristics of the orthodontist's professional scope.

METHODS

The developed questionnaire had its psychometric properties evaluated and was applied to 220 young people and adults, aged 18-70 years, who responded according to their perception of 12 manipulated images of orthodontists with different stereotypes, considering the following items: hygiene, care, punctuality, experience and knowledge in orthodontics.

RESULTS

The developed questionnaire showed high acceptability, confirmed reliability and validity of the construct, and satisfactory internal consistency. The stereotype interfered with the perception of professionalism (P <0.01), in which the orthodontist with combined characteristics (beard/loose hair, piercing, earrings, and tattoo) obtained the lowest mean scores, both for each item of the questionnaire individually (P <0.01) and in total (P <0.01). Health professional (P = 0.427) and educational level (P = 0.285) status did not influence the perception; however, there was a significant difference for the age groups (P = 0.041).

CONCLUSIONS

The developed questionnaire proved to be valid and reliable for application. Orthodontists with piercings and tattoos on the face and neck were considered less professional. Being a health professional and educational level status did not influence the perception. However, older subjects (aged 51-70 years) were more critical in judging stereotypes than younger subjects (aged 18-30 years).

Did the Use of Minimum Interventions for Caries Management Change during the COVID-19 Pandemic? A Cross-Sectional Study

The aim of this study was to evaluate changes in the frequency of use of minimum intervention (MI) techniques for caries management during the COVID-19 pandemic. A questionnaire was applied through the SurveyMonkeyTM platform to evaluate changes in the dentist's frequency of use of noninvasive, microinvasive, minimally invasive, and mixed interventions, nonaerosol or aerosol productive, to manage dental caries before and during COVID-19 pandemic. Differences in the use of MI techniques were analyzed by Wilcoxon test, and the effect size (ES) was calculated. An α = 0.05 was adopted. A total of 781 dentists answered the questionnaire; most of them were female (76.4%), with 30s (76.4%), graduated over 10-24 years ago (38%) in public dental schools (62%), graduated in southwest of Brazil (38%), that work in clinical environment (66.8%) and in private jobs (53.4%). During COVID-19, among the sample, 91 respondents were not working. In relation to the noninvasive techniques, only the use of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) decreased during the COVID-19 pandemic (p < 0.01; ES = 0.11). The frequency of sealants to repair defective restorations was the only microinvasive technique that increased during the pandemic (p < 0.01; ES = 0.03). Among the minimally invasive techniques, the use of atraumatic restorative treatment increased significantly (p < 0.01; ES = 0.06), while the use of air abrasion decreased (p = 0.02; ES = 0.04) during COVID-19 pandemic. Moreover, nonrestorative cavity control (mixed intervention) increased during pandemic period (p < 0.001; ES = 0.11). Although the results demonstrated differences in the use of some procedures, a very small magnitude of the effect was perceived, demonstrating that the influence of COVID-19 pandemic was very little, if any, in the use of MI techniques for caries management. Moreover, the use of MI strategies was already well established between Brazilian dentists before the pandemic period.

Effect of an aqueous 4% titanium tetrafluoride solution on preventing caries in orthodontic patients: a controlled clinical trial

INTRODUCTION

Titanium tetrafluoride (TiF4) is a fluoride compound that, when is applied over enamel, promotes a protection against demineralization through a titanium dioxide (TiO2) acid-resistant coat.

OBJECTIVES

This study sought to verify the hypothesis that a single application of 4% TiF4 increases the resistance of enamel to dental demineralization in orthodontic patients.

MATERIALS AND METHODS

This controlled clinical trial followed CONSORT guidelines and investigated the prevention of enamel demineralization, fluoride retention, and the presence of a Ti layer after TiF4 application on banded teeth exposed to clinical cariogenic biofilm. Forty premolars were divided into a control group (CG; n = 20) and a test group (TG; n = 20). Teeth from both groups received prophylaxis and orthodontic bands with a cariogenic locus. In the TG, all teeth additionally underwent aqueous 4% TiF4 solution application after prophylaxis before being banded. After one month, teeth from both groups were extracted and prepared to assess the microhardness, fluoride retention, and evaluation of the Ti coating over the enamel surface. All data were analyzed with a paired Student's t-test (p<0.05).

RESULTS

Enamel microhardness and fluoride uptake were higher in TG than in CG, while the Ti layer could be seen over TG teeth that received TiF4 application.

CONCLUSION

Under clinical circumstances, the 4% aqueous TiF4 solution was effective in preventing enamel mineral loss through increasing the enamel resistance to dental demineralization, enhancing its microhardness and fluoride uptake, and forming a Ti coat.

Emoji as promising tools for emotional evaluation in orthodontics

Background

Emoji are pictograms frequently used in social networks capable of expressing emotions. These tools can provide insights into people's behavior that could not be obtained with the use of textual communication. Recently, emoji have been introduced to various research fields as successful alternatives to word-based questionnaires for measure emotional responses. The objective of this study was to preliminarily evaluate the discriminating ability and relationship of these tools with different occlusal conditions/malocclusions.

Methods

Online surveys were applied to adult individuals (n = 201; mean age = 27.4 ± 5.7; 37.3% males, 62.7% females). Subjects issued acceptance scores (10-point scale) and expressed their emotional status using a 30-emoji list in relation to nine occlusal conditions: C1–crowding, C2–anterior open bite, C3–interincisal diastema, C4–increased overjet + deep bite (Class II div. 1), C5–anterior crossbite (Class III), C6–ideal occlusion, C7–unilateral posterior crossbite, C8–anterior open bite plus bilateral posterior crossbite plus crowding, and C9–deep bite (Class II div. 2). Cochran's Q and McNemar tests were used to compare the frequencies of choice of emoji between conditions. Correspondence analyses were applied to assess the association between occlusal conditions and emoji. Kendall's correlation coefficient was calculated to evaluate the relationship between mean acceptance scores and frequency counts of each emoji.

Results

The frequency of choice between conditions showed a significant difference for 25 of the 30 emoji (P < 0.05), indicating an adequate discriminating ability of these tools. Emoji were grouped predominantly based on their emotional valence (positive/negative) and arousal/activation (high/low). Positive emoji were associated with the most accepted conditions (i.e., C6, C3), while negative emoji with the most rejected ones (i.e., C8, C1, C2). Although only weak, positive correlations between acceptance and positively valenced emoji, and negative correlations between acceptance and negatively valenced emoji were observed (P < 0.05).

Conclusions

Emoji have an adequate discriminatory ability and would allow determining emotional profiles in the face of different occlusal conditions. Further research is necessary to consolidate the use of these tools in an instrument that allows measuring emotional responses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40510-022-00418-3.

Distalization of maxillary molars with Invisalign aligners in nonextraction patients with Class II malocclusion

INTRODUCTION

This retrospective study aimed to evaluate whether the treatment of Class II malocclusion with Invisalign aligners with sequential distalization of posterior teeth in adult patients would meet the criteria of American Board of Orthodontics (ABO) standards for the treatment and assess the predictive value of ClinCheck Pro software with the final results comparing the initial time, predictive planning using ClinCheck Pro software, and the final time without any require refinement.

METHODS

The sample consisted of 32 adult patients with Class II malocclusion (n = 32 [7 men and 25 women]; mean age 35.47 ± 9.61 years). All of them used a set of Invisalign aligners; no refinement set was evaluated. The 7 measurements of the ABO Model Grading System, the millimeter measurements for the anteroposterior ratios of maxillary first molars and the overbite were used in the evaluations and were compared in phases initial time, predictive planning using ClinCheck Pro software, and the final time. For the intraexaminer reliability test, the intraclass correlation coefficient was calculated to analyze the reliability of the measures. The Shapiro-Wilk normality test was used to examine whether the variables were normally distributed. The Wilcoxon nonparametric test for paired samples was applied for variables that did not show normal distribution. The parametric Student t test for paired samples was used for variables that presented normal distribution. The significance level adopted for this study was 0.05.

RESULTS

In comparison between final ClinCheck and posttreatment results, the ABO index showed a statistically significant difference between the predictions and results for alignment and rotation, buccolingual inclination, overjet, occlusal contact, occlusal relationship, molar relationship, and overbite. The final score of the ABO scores did not meet the standards for Class II correction, contrary to what the ClinCheck Pro software predicted.

CONCLUSIONS

The null hypothesis that distalization of the posterior teeth occurs in adult patients using Invisalign aligners was rejected. The treatment of Class II malocclusion with Invisalign aligners did not occur as estimated by the virtual planning prepared by ClinCheck according to the standards for evaluating occlusal results established by the ABO at the end of the use of a set of aligners with sequential distalization.

Social attractiveness perception of a cleft lip repair in an adolescent via eye-tracking

PURPOSE

The present study was designed to investigate the perception of unilateral cleft lip (UCL) repair scar using an image of an adolescent and eye-tracking technology.

MATERIAL AND METHODS

Frontal and oblique views of an image of an adolescent with a unilateral upper lip scar result of a corrective surgery. Eighty-five laypeople respondents were divided into three groups: Group A (15-44 years of age); Group B (45-59 years of age); and Group C (≥ 60 years of age). Gaze tracking was carried out to assess the location on the image of greatest fixation, to create dot maps and to follow the trajectory of the gaze. Respondents also assessed six attention questionnaires. The answers and assessment of the VAS were compared. P-values &lt;0.05 were considered significant in the analyses.

RESULTS

The central focus of the visualization was concentrated on the upper lip and the region of the nostril, followed by the eyes. Time until 1st fixation upon right lip and mouth showed differences with regard to different images. Images of the model shown in various guises including smiling or not, in a frontal or oblique views showed significant differences in VAS scoring (p&lt;0.001).

CONCLUSION

The presence of a scar from the UCL repair in an adolescent was noted in the foreground by laypeople. The scar was associated with a lower degree of attractiveness, happiness, and intelligence, as well as with shyness and sympathy, although a visible scar did not influence the perception of "good hygiene habits".

The effect of socioeconomic aspects and dental history on pediatric patients' dental anxiety

This study aimed to characterize the profile of dental anxiety in pediatric patients, identifying the effect exerted by socioeconomic factors using dental data. A cross-sectional study design with a sample of 120 children aged 7-12 years old was used. Data relating to anxiety levels prior to dental care, socioeconomic aspects (family income, education level, child's school type), and child's dental history (previous dental appointments, previous treatment, caries experience) were collected. Additionally, participants completed the Brazilian version of the Children's Fear Survey Schedule- Dental Subscale (B-CFSS-DS) to assess dental anxiety. Descriptive analyses, chi-squared (X 2 ) tests, and Mann-Whitney U tests were performed, with a significance level of 5%. A total of 51 boys (42.5%) and 69 girls (57.5%) were included. There was no significant difference in dental anxiety between them. However, younger children had higher mean B-CFSS-DS scores (p = 0.036, Mann-Whitney). A higher prevalence of dental anxiety was found in participants from low-income families (p = 0.012, X 2 ) and in patients who did not receive endodontic treatment (p=0.034, X 2 ). Higher mean B-CFSS-DS scores were also observed in participants who did not receive endodontic treatment (p=0.001, Mann-Whitney) compared with those that did receive endodontic treatment. No relationship was found between education level, patient school type, first dental appointment, caries experience, and dental anxiety data. Younger children presented a profile of greater dental anxiety. Socioeconomic factors and dental data exerted some effect on dental anxiety, where children from low-income families and those not subjected to endodontic treatment displayed higher rates of dental anxiety.

Information and Communications Technology in Dentistry: an informative and educational approach for patients with fixed orthodontic appliances

Objective:

To develop and make available, at no cost to the user, Information and Communications Technology (ICT) tools for Dentistry, providing dental information and advice geared toward patients undergoing orthodontic treatment with fixed appliances.

Material and Methods:

A Dentistry-based content that contemplated information and advice concerning orthodontic treatment with fixed appliances was elaborated. The materials, which included instructions on oral hygiene and treatment strategies when faced with possible complications, were evaluated and validated by specialists, whose assessments reached a 85% approval. From the validated content, products using four distinct ICT tools were formulated.

Results:

The following technological products were developed: a program for community radios, three blog posts, four educational and informative videos, and a smartphone application - using texts, as well as images and videos. These ICT tools, geared toward patients wearing fixed orthodontic appliances, were made available by internet at no cost to the user, and the number of accesses is already expressive.

Conclusion:

These technological-scientific tools, developed and provided freely to the population, can aid patients during their treatment with fixed orthodontic appliances, contributing to the dissemination of reliable information, and clarifying doubts that may arise during orthodontic therapy. These free ICT tools serve to facilitate access to scientific knowledge, thereby favoring social inclusion, bearing in mind that this educational and informative material was offered in a simple and accessible manner to the general population.

Visual perception of repaired cleft lip scarring face associated with different malocclusions via eye-tracking

Background. This study aimed to evaluate the visual facial perception in response to scars associated with repaired cleft lip (CL) on a male adolescent patient, as assessed via eye-tracking. Methods. Index of orthodontic treatment need (IOTN) malocclusions, grades 1, 5, and 8 were added to the frontal view facial image of an adolescent male model showing asymmetries of the nose and upper lip after CL surgery using the software Photoshop CS5® software. The eye movements of 91 laypeople observers were tracked by an Eye Tribe infrared sensor connected to OGAMA© software. A Kruskal–Wallis test was used to identify differences in total fixation time and time until the first fixation for the areas of interest. A visual analog scale (VAS) of attractiveness was also used in the study. Statistical analysis was performed adopting a significance level of P<0.05. Results. The area of interest (AOI) were found to be the mouth and teeth, which were more focused on gazed at than any other area, regardless of the grade of IOTN. For observers of different ages, there were significant differences in the time until the first fixation on the scar of the repaired CL region for IOTN grade 1 (P=0.007). Images showing IOTN grade 1 repaired CL regions received the highest VAS scores. The older the age, the greater the tendency to give a higher VAS score for the same malocclusion. Conclusion. The presence of a CL scar on the upper lip did not attract the eye of laypeople observers of different ages, regardless of the degree of malocclusion in the non-smile image. The age of the observers did influence the perception of attractiveness, with older observers giving higher scores than younger ones. As the severity of the malocclusion increased, they were found to be less attractive.

Therapeutic approach in Class I malocclusion with impacted maxillary canines

Objective:

To emphasize the importance of diagnosis and discuss the therapeutic approaches that can be used in the orthodontic treatment of Class I malocclusion associated with two impacted maxillary canines. The opening of spaces for traction of these teeth by means of rapid maxillary expansion or extraction of maxillary premolars was contraindicated in the case reported. Therefore, it was decided to open spaces with projection of incisors.

Results:

The obtained results were satisfactory, as a good occlusion was obtained, with adequate functional guides, as well as an improvement in the facial appearance.

Conclusion:

The projection of the incisors prior to traction of the impacted maxillary canines proved to be a valid option in the case described. Ten years after completion of treatment, the case is stable, maintaining periodontal health.

Facial Type, Sex and Skin Color of Pediatric Patients Are Associated with Dental Students' Empathy and Self-Confidence During Dental Care

Purpose: To assess the levels of empathy and self-confidence of pre- and post-doctoral dental students during the dental care of children of different facial types, sex and skin color.<br/> Methods: A cross-sectional survey was conducted with 170 Brazilian dental students. Photos of four mesofacial pediatric patients of different sex (male, female) and skin color (white, black) were digitally altered to dolichofacial and brachyfacial facial types. The 12 photos obtained (four originals and eight digitally altered) were projected during lectures and students reported their level of empathy (scores from zero to 10) and self-confidence (not confident/confident) using a structured questionnaire, based exclusively on children's appearance. Bivariate analysis and Poisson robust regression were performed (P <0.05).<br/> Results: Students' lower empathy was observed among brachyfacial children (preva- lence ratio [PR] = 0.940; 95 percent confidence interval [95 percent CI] = 0.904 to 0.978). Female (PR=1.202; 95 percent CI=1.162 to 1.243) and black children (PR=1.068; 95 percent CI=1.035 to 1.103) received students' higher empathy scores. Higher percentages of self-confidence were associated with mesofacial (P =0.049), female (P <0.001), and black (P =0.001) children. Students' lower self-confidence was associated with brachyfacial (PR=1.106; 95 percent CI=1.066 to 1.147), male (PR=1.202; 95 percent CI=1.165 to 1.239) and white (PR=1.056; 95 percent CI =1.025 to 1.088) pediatric patients.<br/> Conclusions: Brachyfacial children were associated with dental students' lower levels of empathy and self-confidence while female and black children received higher levels of empathy and self-confidence. However, dental students felt less confident regarding the dental care of white children.

Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review

The purpose of this review was to systematically evaluate all the existing literature on the efficacy of treatments used to relieve the signs and symptoms associated with teething. A systematic search up to February 2021, without restrictions on language or date of publication, was carried out in MEDLINE/PubMed, SCOPUS, Web of Science, The Cochrane Library, EMBASE, LILACS, BBO, OpenGrey, Google Scholar, Portal de Periódicos da CAPES, clinicaltrials.gov, and the references of the included studies. Clinical studies that evaluated the effect of any intervention to alleviate the signs and symptoms associated with teething in babies and children were included. The risk of bias was assessed using the ROB-2 and ROBINS-I tools. The characteristics and results of the individual studies were extracted and synthesized narratively. The GRADE approach was followed to rate the certainty of the evidence. Three randomized and two non-randomized clinical trials were included. The outcomes of these five articles were classified as high or serious risk of bias. Three studies using homeopathy reported improvement in appetite disorders, gum discomfort, and excess salivation. One study showed a new gel with hyaluronic acid was more effective than an anesthetic gel in improving signs and symptoms such as pain, gingival redness, and poor sleep quality. Another study applied non-pharmacological treatments, which were more effective, especially against excess salivation. Although the present systematic review suggests some therapies could have a favorable effect on signs and symptoms related to teething, definitive conclusions on their efficacy cannot be drawn because of the very low certainty of the evidence. The existing literature on the subject is scarce and heterogeneous and has methodological flaws; therefore, further high-quality investigations are necessary.

Influence of chlorhexidine digluconate on biocompatibility of cements: Morphological and immunohistochemistry analysis

In this study, the in vivo biocompatibility was evaluated by using conventional ionomer cements modified with Chlorhexidine (CHX) in different time intervals. In total, 105 male Wistar rats were randomized into seven groups: control, groups M, M10, M18 and groups RL, RL10, RL18 (M-Meron and RL-RivaLuting, and added CHX-10% and CHX-18%, respectively). Histological analyses of inflammatory infiltrate and collagen fibers, and immunohistochemistry of CD68+ for macrophages (MOs) and multinucleated giant cells (MGCs) were performed. Data were analyzed using the Kruskal-Wallis and Dunn (p < .05) tests. Intense inflammatory infiltrate was demonstrated in Group Riva CHX-18% within 7 and 15 days (p < .05), without differences after 30 days. For collagenization, healing of the groups was compatible with that of control in 15 and 30 days (p > .05). Immunomarking of CD68+ was more significant in the groups with higher concentration of CHX. There was significant difference in quantity of MGCs in groups with 18% CHX, Meron (p = .001) in 7 days, and in Riva at 30 days (p = .001). Significant difference was also found in quantities of MOs in Groups Meron and Riva in 7 days (p = .001), and only in Riva at 15 and 30 days (p = .001). The cements with addition of CHX demonstrated biocompatibility with tissues. Riva CHX-18% had the most effect on cells of the inflammatory process but showed satisfactory tissue repair.

The influence of malocclusion on social aspects in adults: study via eye tracking technology and questionnaire

BACKGROUND

Smile esthetics has a strong influence on perception, attractiveness, and personal characteristics. It is unknown how malocclusions may influence the appearance of the individual's smile. This study aimed to investigate whether malocclusion affects the visual perception of esthetics, age, employability, honesty, intelligence and to meet its obligation in time in middle-aged adults. Facial frontal smiling photographs of a male and a female middle-aged adult with 3 different malocclusions were shown to and evaluated by 90 laypeople (non-dentists), divided into groups: young adults (14-44 years), middle-aged adults (45-59 years), and elders (over 60 years). The index of treatment need (IOTN) was used, and IOTN 1, 5, and 8 images were created in Photoshop using the male and female photographs. In total, 6 photographs were evaluated, 3 areas of interest (AOI)-eyes, nose, and mouth-were created for statistical comparison. The Ogama and Eye Tribe tracker were used in conjunction to measure eye tracking. A visual analog scale (VAS) was employed with a questionnaire surveying individuals' perception of age, employability, honesty, intelligence, and ability to meet obligations. Kruskal-Wallis, one-way analysis of variance, Pearson's-chi-squared, and Pearson correlation test were applied.

RESULTS

No statistical difference was found in complete fixation time and time until the first fixation for each AOI for eye-tracking. VAS showed statistical differences in the male and female IOTN 1 images when compared with the IOTN 5 and 8 for both models, and there was no difference between genders in the IOTN 1. As the perceived age of the model increased, the chances of getting hired decreased. Employability, honesty, intelligence, and ability to meet obligations showed higher values for IOTN 1. There were significant differences between age ranges; perception of intelligence in the female IOTN 1 model (p = 0.002) and IOTN 8 model (p < 0.001) and honesty between young adults and middle-aged adults in the male IOTN 1 and 8 images (p < 0.001).

CONCLUSIONS

There was a difference between age groups in the perception of honesty and intelligence. A well-balanced and attractive was perceived as more youthful and attractive in both genders and may increase the chance of being selected for a job interview or being hired.

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.

Clinical parameters in soft tissue adjunctive periodontal procedures for orthodontic patients: surgical laser vs scalpel -: A systematic review

OBJECTIVES

To systematically review existing literature regarding clinical parameters comparing surgical laser and conventional surgery with scalpel for soft tissue adjunctive periodontal procedures in orthodontic patients.

METHODS AND MATERIALS

MEDLINE, Scopus, Web of Science, The Cochrane Library, LILACS, Bibliografia Brasileira de Odontologia (Brazilian Dental Literature - BBO), Embase, Open Grey, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Coordination for the Improvement of Higher Education Personnel - CAPES), and Google Scholar were searched up to December 2020 without language restriction. Clinical trials comparing clinical parameters from surgical laser and conventional surgery with scalpel for soft tissue adjunctive periodontal procedures in orthodontic patients were selected. Risk of bias (RoB) assessments were performed using the Cochrane RoB2 tool. Narrative syntheses were performed, and the certainty of evidence was determined using the GRADE tool.

RESULTS

Five randomized clinical trials were included. One study was rated as low RoB, whereas others presented some concerns or high RoB. The studies were highly heterogeneous in relation to the procedure performed, laser protocol, outcomes evaluated, and follow-up periods. In general, regardless of the procedure and laser protocol used, the studies did not show significant differences between laser and scalpel for the outcomes of probing pocket depth, clinical crown length, gingival index, and relapse rate. Pain and bleeding were significantly lower with the use of laser compared with the scalpel. The certainty of evidence ranged from moderate to very low.

CONCLUSIONS

The existing literature on the subject is scarce and very heterogeneous and has methodological limitations. Based on the available evidence, it is not possible to draw definitive conclusions about the beneficial effect of laser use in orthodontic patients.

Does the premature loss of primary anterior teeth cause morphological, functional and psychosocial consequences?

Premature loss of primary anterior teeth in deciduous arches is a controversial topic in the literature, especially due to the lack of robust scientific evidence regarding the types and magnitudes of the consequences involved. Morphological, functional, and psychosocial problems may arise from untreated premature loss of primary incisors and canines. The morphological problems include impaction and eruption disturbances of permanent successors; inclination and/or extrusion of adjacent and antagonist teeth, respectively; midline deviation; and crowding. Functional complications, such as speech disorders, aesthetic problems, and development of non-nutritive habits may occur, resulting in psychosocial implications, including a decrease in self-esteem, and even being targeted for bullying. The current critical review aimed to present and discuss the evidence available in the literature about the etiology, characteristics, implications and interventions resulting from the premature loss of primary anterior teeth. It is of utmost importance that future studies be developed to support the clinical decisions made by dental professionals on this topic.

Development, validation and application of a Brazilian knowledge scale about sports doping in dentistry

To evaluate the knowledge of Brazilian dentists of sports doping through the development, validation and application of the Brazilian Knowledge Scale about Sports Doping in Dentistry (B-KSSDD). A scale with 12 items was developed to assess a dentist's ability to determine whether the use of a medication characterised sports doping according to the World Anti-Doping Agency. A preliminary study to validate the B-KSSDD was carried out with 135 dentists, allowing the evaluation of ceiling and floor effects, convergent and discriminant validity, test-retest reliability and internal consistency of the instrument. A sample size calculation using the results of the preliminary study and the B-KSSDD was completed online using SurveyMonkey® by 270 participants from all regions of the country. The B-KSSDD showed evidence of convergent and discriminant validity, good temporal stability (ICC = 0.75) and internal consistency (alpha = 0.89). In the main study, the participants obtained an average score of 4.19/12 points on the B-KSSDD, suggesting that these professionals have insufficient knowledge about sports doping. The age of participants showed a negative association with knowledge about doping, while frequency of treating athletes and frequency of performing surgeries showed positive associations with knowledge about doping. The dentists had insufficient knowledge of the subject. Age of participants and frequency with which they attend to athletes are associated with knowledge about sports doping. Professional updating and education policies on doping are necessary for dentists, as athlete patients are at risk for severe sporting and financial penalties.

In vitro effect of experimental nanocomposites solutions on the prevention of dental caries around orthodontic brackets

This study aimed to evaluate the in vitro effect of a single application of experimental nanocomposite solutions on the prevention of dental caries around orthodontic brackets. The specimens were exposed to mesoporous silica (MS) nanocomposites containing fluoride by association with titanium tetrafluoride (TiF4) or sodium fluoride (NaF). Nanocomposites also could contain calcium and groups were described as MSCaTiF4, MSTiF4, MSCaNaF, MSNaF, and controls (TiF4, and NaF). Specimens were subjected to the formation of a multispecies biofilm to generate a cariogenic challenge. After 24h, both pH and total soluble fluoride concentration of the culture medium were assessed. Mineral loss was evaluated by percentage of surface mineral loss (%SML), mineral volume variation (ΔZ) of inner enamel and polarized light microscopy (PL). Linear (Ra) and volumetric (Sa) surface roughness and scanning electronic microscopy (SEM) were used to assess enamel topography. Statistical analyses were conducted considering p<0.05. MSNaF had the highest value of culture medium pH after cariogenic challenge, similarly to MSTiF4. All nanocomposite solutions released less fluoride than their controls NaF and TiF4 (p<0.05). All nanocomposite solutions presented lower %SML compared to their respective control groups (p<0.05). Lower Ra, Sa and ΔZ were observed for experimental groups compared to TiF4 (p<0.05). The results were confirmed by PL and SEM analysis. The experimental nanocomposite solutions contributed for lower enamel demineralization around orthodontic brackets.

Visual facial perception of postsurgical cleft lip scarring assessed by laypeople via eye-tracking

OBJECTIVES:

This study aimed to evaluate the visual facial perception in response to scars associated with repaired cleft lip (CL) on a male adolescent model, as assessed by eye-tracking technology.

MATERIAL AND METHODS:

Unilateral and bilateral facial images of repaired CL on the upper lip and nasal asymmetry were added to an image of a male adolescent model, using Photoshop CS5 software. 40 laypeople eye movements were tracked by an infrared sensor of the Eye Tribe hardware in conjunction with OGAMA software. An analysis of variance was used to identify differences in total fixation time for the added areas of interest. A visual analog scale of attractiveness with a questionnaire were also incorporated into the study. Statistical analysis was performed using a significance level of P < 0.05.

RESULTS:

Significant differences were noted between the image with no scar and the image featuring a unilateral scar for total fixation time associated with the right eye (p = 0.002) and right nose area (p = 0.003), in addition to the numbers of fixations for the right eye (p = 0.005) and right nose area (p = 0.007). Comparing the image with no scar with the image featuring a bilateral scar showed a significant difference only for the number of fixations on the right eye (p = 0.005). The heatmaps and fixation point maps for both the unilateral and bilateral scar images indicated increased fixation for the scar areas. For the image with no scar, increased fixation was captured for the right eye area. Pearson's correlation coefficient test showed a moderate positive (p = 0.692) relationship when comparing to unilateral and bilateral cleft scars.

CONCLUSIONS:

The participating laypeople perceived the cleft-repaired faces and did not perceive any difference in attractiveness between the images featuring the unilateral and bilateral postsurgical clefts and lip scarring.

Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: A randomized controlled trial

INTRODUCTION

This trial aimed to longitudinally evaluate the effect of the treatment of transverse maxillary deficiency using rapid palatal expansion (RPE) on self-perceived oral health-related quality of life (OHRQOL) in children.

METHODS

Eighty participants aged 8-10 years with transverse maxillary deficiency and bilateral posterior crossbite were randomly assigned to 2 groups (n = 40 each): a group treated with RPE using hyrax-type appliances and a nontreated control group. OHRQOL was assessed by using the Child Perceptions Questionnaire for 8-10-year-olds at 4 times: before RPE, during RPE (T₁), at the end of RPE (T₂), and 1 month after the appliance removal (T₃). Generalized mixed models were used for data analysis (α = 0.05).

RESULTS

Both groups exhibited similar demographic characteristics and OHRQOL scores at baseline. All participants completed the study. RPE had a time-dependent effect on OHRQOL. At T₁ and T₂, this therapy is expected to increase the overall OHRQOL scores by 1.17 times (ie, ∼17% increase; T₁ 95% confidence interval [CI], 1.08-1.26; T₂ 95% CI, 1.09-1.27; P = 0.001). In contrast, the overall OHRQOL scores at T₃ are expected to be 0.28 times the baseline scores (ie, ∼72% reduction; T₃ 95% CI, 0.26-0.31; P = 0.001). All individual domains of the OHRQOL evidenced a positive impact of treatment at T₃ (P = 0.001). Only the oral symptoms and social well-being domains showed a significantly negative impact of the treatment at T₁ and T₂.

CONCLUSIONS

Correction of the transverse maxillary deficiency by RPE in children aged 8-10 years improves OHRQOL. There is a temporary worsening of OHRQOL during the treatment of this condition using RPE.

REGISTRATION

This trial was not registered.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil, Financing Code 001.

Stress and displacement of mini-implants and appliance in Mini-implant Assisted Rapid Palatal Expansion: analysis by finite element method

Objective:

In this study, simulations were performed by the finite element method (FEM) to determine the tension and displacement in mini-implants and in expander appliance during rapid maxillary expansion, by varying the number and location of the mini-implants.

Methods:

For the computational simulation, a three-dimensional mesh was used for the maxilla, mini-implants and expander appliance. Comparisons were made on six different Mini-implant Assisted Rapid Palatal Expander (MARPE) configurations, by varying the amount and location of mini-implants. A closed suture was design and received two activations of 0.25 mm, and an open suture had a 0.5-mm aperture that received 20 activations, also of 0.25 mm.

Results:

For the closed suture, the maximum displacement values in the mini-implants were between 0.253 and 0.280 mm, and stress was between 1,348.9 and 2,948.2 MPa; in the expander appliance, the displacement values were between 0.256 and 0.281 mm, and stress was between 738.52 and 1,207.6 MPa. For the open suture, the maximum displacement values in the mini-implants were between 2.57 and 2.79 mm, and stress was between 5,765.3 and 10,366 MPa; in the appliance, the maximum displacements was between 2.53 and 2.89 mm, and stress was between 4,859.7 and 9,157.4 MPa.

Conclusions:

There were higher stress concentrations in the mini-implant than in the expander arm. In the simulations with a configuration of three mini-implants, stress overload was observed in the isolated mini-implant. Displacements of the mini-implants and arms of the appliance were similar in all simulations.

Can text messages encourage flossing among orthodontic patients?

OBJECTIVES

To assess the extent to which text messages on WhatsApp play a role in patient awareness of the importance of proper oral hygiene and flossing on a daily basis and to test the null hypothesis that daily text messages do not influence the flossing habits of orthodontics patients.

MATERIALS AND METHODS

Forty-four patients wearing fixed orthodontic appliances with a mean age of 14.3 years participated in the study. Patients (male and female) were randomly assigned to two groups (n = 22): group 1, text messages sent via WhatsApp daily during the study period, and group 2 (control), no text messages received. Plaque index, gingival bleeding index, and halitosis were assessed at baseline and after 30 days. The results were analyzed and subjected to normality test, McNemar test, Fisher exact test, Mann-Whitney test, and Wilcoxon signed-rank test.

RESULTS

There was a significant influence on flossing habits (P < .05) and a significant reduction in plaque and gingival bleeding indices in group 1 (P < .05). Group 1 had a significant reduction in halitosis (P < .05).

CONCLUSIONS

Daily text messages seem to influence patient awareness of the importance of proper oral hygiene and flossing. The null hypothesis was rejected because those patients who received text messages every day changed their flossing habits.

Factors associated with depression, anxiety and stress among dentists during the COVID-19 pandemic

The objective of this work was to evaluate the relationship between factors associated with the COVID-19 pandemic and depression, anxiety, and stress (DAS) in dentists. Factors associated with the COVID-19 pandemic were evaluated using a questionnaire and scores of the Depression, Anxiety, and Stress Scales-21 were measured. The differences between the DAS scores based on the factors associated with the COVID-19 pandemic were tested through the successive application of multivariate analysis of variance (MANOVA, α = 0.05). After a sample size calculation, 998 participants with a mean age of 39.39 (± 11.69) years were included. The effect size indicated that changes in sleep quality (η2 = 0.161), eating habits (η2 = 0.057), and physical health (η2 = 0.051) were the ones that most negatively affected DAS scores. The highest DAS scores were observed in professionals who lived with someone at high-risk for COVID-19 (p < 0.001) and in those who did not engage in leisure activities during the pandemic (p < 0.001). Dentists who worked on the frontline against COVID-19 had higher scores of anxiety and stress (p = 0.029). The highest scores for anxiety, depression, and/or stress were seen in dentists living with someone at high-risk for COVID-19, who acts on the frontline, who does not practice in leisure activities during the pandemic, who completely changed eating habits, quality of sleep and physical health during the pandemic. In general, DAS levels of dentists were associated with factors related to the COVID-19 pandemic.

Effect of Yellow Propolis on Biocompatibility of Cements: Morphological and Immunohistochemistry Analysis

Objective  The focus of this study was to evaluate the biocompatibility of ionomer cements modified with ethanolic extracts of propolis (EEP) in different concentrations and time intervals.

Materials and Methods  In total, one hundred and thirty-five male Wistar rats were randomized into nine groups: Control, Groups Meron, and Groups Ketac (conventional, and added with 10, 25, 50% EEP, respectively). Histological analyses of inflammatory infiltrate and collagen fibers, and immunohistochemistry of CD68+ for macrophages (MOs) and multinucleated giant cells (MGCs) were performed.

Statistical Analysis  Data were analyzed using the Kruskal—Wallis and Dunn ( p < 0.05) tests.

Results  Intense inflammatory infiltrate was demonstrated in the cements with 10% EEP at 7 days and 15 days ( p < 0.05), only Group Ketac 10% EEP ( p = 0.01) at 30 days. A smaller quantity of collagen fibers was observed in the cements with 10% EEP ( p = 0.01) at 7 days, and Group Meron 10% EEP ( p = 0.04) at 15 days. MOs and MGCs showed significant difference for the cements with 10% EEP ( p = 0.01) at 7 and 15 days. At 30 days, MOs persisted in the Groups with 10% EEP.

Conclusions  The concentration of 10% EEP had the greatest influence on the inflammatory and tissue repair processes. The concentrations of 25 and 50% EEP demonstrated biocompatibility similar to that of cements that did not receive EEP.

Biomonitoring of children and adolescents using orthodontic appliances made of acrylic resins through micronucleus testing of exfoliated buccal and palatal mucosa cells

INTRODUCTION

The present study aimed to investigate the occurrence of micronuclei and the degenerative nuclear alterations indicative of apoptosis and necrosis in the exfoliated buccal and palatal mucosa cells of children and adolescents using orthodontic appliances made of self-curing acrylic resins.

METHODS

The micronuclei and nuclear alterations were evaluated in a minimum of 2000 cells collected from the cheeks and palates of 30 patients of both sexes, aged between 6 and 12 years. The cell evaluations were performed before appliance installation and 15 to 21 days after installation. A conditional test was used. In all analyses, the significance level was 5%.

RESULTS

No differences in the occurrence of micronuclei or the nuclear degenerative changes indicative of apoptosis and necrosis were observed in the cheek cells between the 2 time points (P > 0.05). However, evaluation of the palate cells revealed a significant increase in the occurrence of micronuclei and the nuclear alterations indicative of apoptosis (P < 0.01) but not of karyolysis (P > 0.05).

CONCLUSIONS

Direct contact of orthodontic appliances made of acrylic resins with the oral mucosa increases the incidence of chromosomal damage and degenerative nuclear alterations.

Impact of oral-health-related quality of life and self-esteem on patients with missing maxillary lateral incisor after orthodontic space closure: a single-blinded, randomized, controlled trial

BACKGROUND

The maxillary lateral incisor is one of the teeth most likely to suffer agenesis, resulting in spacing between the central incisor and the canine.

OBJECTIVE

To compare maxillary lateral incisor agenesis with space closure treatment versus non-treatment based on measurements of the self-perceived oral-health-related quality of life (OHRQoL) and self-esteem of the participants.

SUBJECTS AND METHODS

A total of 44 people, aged 17-49 years, with missing lateral incisors were randomly assigned to two groups (n = 22 in each)-a treated group in which the space was orthodontically closed (TG) and a control group that remained untreated (CG). Randomization was performed by a researcher who was not involved in the clinical part of the study. The outcomes were assessed using the Oral Health Impact Profile and Rosenberg's Self-Esteem Scale, which were applied before (phase 1) and after (phase 2) the orthodontic treatment in the TG, and at baseline (phase 1) and 12 months after (phase 2) in the CG. All the data were blindly evaluated, supporting the single-blinded design of the study.

RESULTS

All participants finished the randomized controlled trial, and the demographic characteristics were similar between the groups. In phase 1, the levels of self-esteem and OHRQoL at baseline were similar (P = 0.079, P = 0.693, respectively). In phase 2, the self-esteem scores of the CG decreased and the OHRQoL increased (P = 0.005, P < 0.001, respectively), while self-esteem increased in the TG and the OHRQoL decreased (P < 0.001). The CG had lower scores than the TG for self-esteem, but the opposite was observed for OHRQoL (P < 0.001).

LIMITATIONS

Information bias may have occurred. Since the questionnaires could not have been applied at the same time in both groups, the time difference between the two assessments may have led to random and systematic error.

CONCLUSIONS

The spacing resulting from missing maxillary lateral incisors had a negative impact on the OHRQoL and self-esteem of the participants, while orthodontically closing those spaces had a positive impact on those aspects.

CLINICAL TRIAL REGISTRATION

This study was not registered.

PROTOCOL

The protocol was not published before trial commencement.

Reasons influencing the preferences of prospective patients and orthodontists for different orthodontic appliances

Objective

To evaluate the reasons influencing the preferences for a certain type of orthodontic appliance over another among prospective patients (PP) and orthodontists.

Methods

A total of 49 PP and 51 orthodontists were asked about their preferences for the following appliances clear aligners (CA), lingual metallic brackets (LMB), polycrystalline and monocrystalline ceramic brackets, and buccal metallic brackets (BMB). The participants rated the importance of 17 potential reasons that would explain their choices. The reasons that contributed most to these preferences were identified. Non-parametric tests (Fisher’s exact, χ² and Mann–Whitney tests) and multivariate analyses (regression and discriminant analysis) were used to assess the data (α = 0.05).

Results

CA and BMB were the most chosen appliances by PP and orthodontists, respectively. LMB was the most rejected option among both groups of participants (p < 0.001). Rates of the importance of pain/discomfort, smile esthetics, finishing details, and feeding/speech impairment showed the highest differences between PP and orthodontists (p < 0.0005). Discriminant analyses showed that individuals who considered treatment time and smile esthetics as more important were more likely to prefer CA, while those who prioritized finishing details and cost were more likely to choose BMB (p < 0.05).

Conclusions

Reasons related to comfort and quality of life during use were considered as more important by PP, while those related to the results and clinical performance of the appliances were considered as more relevant by orthodontists.