The aim of this study was to evaluate the effectiveness of four hygiene protocols for orthodontic mini-implants in reducing the subgingival bacterial load in the peri-implant sulcus. Thirty-nine healthy individuals who had fifty-nine as-received mini-implants (20 men, 19 women, 20 to 42 years old) were randomly distributed into four groups of hygiene protocols: mechanical hygiene (M); mechanical hygiene associated with 0.12% digluconate chlorhexidine (CHX), 0.03% triclosan (T), or 0.05% cetylpyridinium chloride (CP). All individuals were instructed regarding the hygiene procedures (T0). For bacterial load analysis, the gingival crevicular fluid from peri-implant sulcus was collected and submitted to quantitative real-time PCR at baseline (T1) and after 21 days following the hygiene protocols (T2). Wilcoxon test was applied for intergroup comparisons, whereas differences among groups at each time point were examined by Kruskal-Wallis test. The significance level was 5%. Significant difference was detected between baseline and post-protocol times for bacterial total counts, comparing intergroup results, except for mechanical hygiene associated with cetylpyridinium chloride (M p=0.018, CHX p=0.028, T p=0.012, CP p=0.065). No significant difference was detected among the evaluated methods (p=0.181). The mechanical hygiene of orthodontic mini-implants itself was capable to reduce total bacteria load and keep devices clean. Commonly, orthodontists prescribe, in addition to mechanical biofilm removal, some protocols combining adjunctive chemical agents as chlorhexidine. The authors believe that results have large importance for dental community, as they can protect patients from overtreatment.

ABSTRACTIntroduction: Artificial intelligence (AI) in health has increased its applications over the last years. The large amount of data available due to the improvement of data storage and digital exams provided better knowledge in treatment planning and opened new possibilities of applications of AI in Orthodontics’ diagnosis and treatment planning. Objective:The aim of this scoping review was to examine when AI models enhance the clinical decision-making process in orthodontic diagnosis and treatment planning, with a focus on the utilization of X-ray-based imaging. Methods:Individual eletronic search strategies were developed and conducted on PubMed/Medline, Scopus, Web fo Science, Embase, Lilacs, and Cochrane Library (only English language articles published from January 2000 to October 20, 2021), aiming for relevant studies that met the eligibility criteria. Results:12 studies were included, categorized in 5 different groups: Orthognathic surgery, Temporomandibular Joint (TMJ) osteoarthritis, skeletal pattern, obstructive sleep apnea (OSA), and skeletal maturation/development. Most of the AI models used were Deep Learning (DL) based and the X-ray image that was most used was lateral radiographs. Conclusion:Integrating AI into clinical practice will likely continue to evolve, enhancing treatment planning in selective cases. The best applications were over TMJ osteoarthritis, skeletal maturation, and classification, OSA, and the need for orthognathic surgery.

ABSTRACTIntroduction:The demand for aesthetics is high and the desire for white teeth during orthodontic treatment is a desire of patients. Objective:To evaluate the effect of 35% hydrogen peroxide in promoting enamel whitening with orthodontic attachments bonded to its surface. Methods: 80 bovine incisors randomly divided into 4 groups (n=20): (GI) control group, (GII) group that received only tooth whitening, (GIII) group that received only bonding of attachments on the surface and (GIV) group that received bonding of attachments and whitening. Whitening was carried out following the manufacturer’s instructions while the attachments were bonded to the dental surface using a template after acid conditioning of the enamel and application of an adhesive system. Color evaluation was performed according to the LAB color scale of the Commission Internationale de l’Eclairage. Statistical analysis was performed using Jamovi program adopting a 5% significance level. Descriptive data analysis was performed, characterizing all study variables. General linear models adjusted by ordinary least squares regression were used to test the effect of whitening, enhancement use, and the interaction of both factors. Results: Both “whitening” and the use of “attachments” have an effect on all parameters of the CIELAB scale (keeping the other variable constant). The whitening effect was independent of the presence of attachments. Conclusion:35% hydrogen peroxide is capable of promoting enamel whitening with orthodontic attachments bonded to its surface. Clinical Meaning:Despite being in vitro research, the study provides patients and professionals with the possibility of teeth whitening during orthodontic treatment with aligners.

Fixed orthodontic therapy is often accompanied by accumulation of plaque around the orthodontic brackets, which increases the number of periodontopathogenic bacteria. The objective of this study was to determine the changes in the subgingival microflora that occurred six months after the placement of a fixed orthodontic appliance. The study included 30 patients aged 13 to 35 years, in whom samples of subgingival plaque were taken before and six months after the start of fixed orthodontic therapy from the disto-buccal subgingival space of the left upper (U1) and lower central incisors (L1), mesio-buccal subgingival space of left upper (U6) and lower (L6) first molars. Material samples were tested for the presence of the following bacteria: Tannarela forsythia, Treponema denticola, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Prevotella nigrescens and Eikenella corrodens, using the PCR method. A significant increase of patients with presence of bacteria especially in the molar region was found: Tannarela forsythia (U6 T1 10%-T2 80%, L6 T1 16.67%-T2 80%), Porphyromonas gingivalis (U6 T1 60%-T2 90%, L6 T1 60%-T2 83.33%), Prevotella intermedia (U6 T1 23.33%-T2 73.33%, L6 T1 26.67%-T2 76.67%), Prevotella nigrescens (U6 T1 16.67%-T2 63.33%, L6 T1 23.33%-T2 73.33%) and Eikenella corrodens (U6 T1 26.67%-T2 63.33%, L6 T1 23.33%-T2 73.33%) six months after the placement of the fixed orthodontic appliance. In the initial phase of fixed orthodontic therapy, an increase in the number of patients with periodontopathogenic bacteria Tannarela forsythia, Treponema denticola, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens and Eikenella corrodens was observed.

ABSTRACTMethods:The sample was divided into skeletal Patterns I, II and III, based on ANB and Wits appraisal: Pattern I, when ANB angle = 0-4° and BO was ahead AO by 1mm in males (SD = 1.17 ± 1.9mm), 0mm in females (SD = -0.10 ± 1.77mm); Pattern II, when ANB >4° and BO was located behind AO (43 subjects); and Pattern III, ANB < 0° and BO was ahead of AO (43 subjects). Each group had 43 lateral cephalograms, with a total of 129 cephalograms. The samples were divided into three groups only if they satisfied the criteria of both ANB and Wits appraisal. For this, 26 selected landmarks were identified and, using 13 linear measurements, facial soft tissue thickness and pharyngeal airway widths were measured and compared among the different skeletal patterns. Results: There was statistically significant difference in facial soft tissue thickness in the different skeletal patterns. Labrale superius and stomion were statistically significant and higher in Pattern III and smaller in Pattern II. Labrale inferius was found to be statistically significant and higher in Pattern II and smaller in Pattern III. Though not statistically significant, the thickness at Menton, Pogonion, and Gnathion was higher in Pattern II, average in Pattern I and smaller in Pattern III. Sexual dimorphism was noted: Men had a greater soft tissue thickness than women in all sites. There was statistically significant difference in pharyngeal airway widths in different skeletal malocclusions. Both upper and lower pharyngeal airway widths were found to be statistically significant and higher in Pattern III and smaller in skeletal Pattern II. Conclusion: When developing orthodontic treatment plans, soft tissue differences and pharyngeal airway widths need to be taken into account as crucial factors. The findings of the current study indicate that there was a substantial correlation between the thickness of the soft tissues in the face, the diameter of the pharynx, and several skeletal patterns.

ABSTRACTIntroduction:Nasopharyngeal obstruction may influence craniofacial growth, lead to psychosocial impairments, and adversely affect quality of life. Thus, it is important to identify the potential of orthodontic therapies to alter the dimensions of the airways. Objectives:To evaluate the long-term changes in pharyngeal airway dimensions in skeletal Class II patients treated with cervical headgear appliance.Material and Methods: A retrospective study was conducted with 20 patients treated by an experienced Orthodontist. The airway space was assessed using linear and area measurements on cephalometric radiographs before treatment, after treatment, and at a 25-year follow-up. Results:measurements showed high to moderate reliability. None of the measures showed a decrease after treatment. The nasopharyngeal, oropharyngeal, and hypopharyngeal areas were not modified after headgear intervention and showed a tendency to narrow over the follow-up period. Regarding linear measurements, the nasopharyngeal dimensions remained unchanged or increased after treatment, returning to initial dimensions in the follow-up assessment. Conclusion: Orthopedic treatment with extraoral appliances did not cause a decrease in pharyngeal airway dimension and is considered safe for the treatment of growing skeletal Class II malocclusions according to the results of the present study.

ABSTRACTIntroduction:Rapid maxillary expansion (RME) is an orthopedic procedure used to correct maxillary transverse deficiencies by applying forces through specialized appliances. This intervention induces both dental and skeletal changes, which may potentially elicit physiological stress responses. Objective:To validate a model for estimating stress by measuring plasma cortisol levels in mice subjected to rapid RME. Methods: 5-6-week-old male mice (C57BL6/J) were submitted to RME performed by an opening loop distractor at the mid palatal suture calibrated as follows (n = 5 per group): no force (control); 0.28 Newtons (N), 0.42N and 0.56N for periods of 7 and 14 days. Histomorphometry analyses were performed to analyze RME effect and serum samples were collected to measure cortisol by enzyme-linked immunosorbent assay (ELISA). Results:The forces applied at two different time points resulted in a successful RME pattern with the opening of the mid-palatal suture compared to the control group (P<0.05). The 0.42N force at 7 days resulted in a significant (P<0.05) increase in cortisol (pg/ml) compared to the control and 0.28N at 7 days (d) groups; the cortisol level in the 0.42N 7d group was statistically reduced when compared to the 0.42N 14d group. There was no statistically significant difference between the other groups. Conclusion:The results suggest an increase in the stress response during the first days after the application of RME force with a force of 0.42N, with subsequent body adaptation. The force parameter of 0.42N at days proved to be a valid model for analyzing RME in mice.

Developmental Enamel Defects (DED) pose a significant challenge for clinicians, particularly orthodontists. These defects can lead to difficulties in differential diagnosis, orthodontic appliance adhesion, treatment planning, and overall patient management. The present review aims to provide orthodontists with a comprehensive understanding of DED and their implications for orthodontic treatment. A systematic literature search was conducted to identify relevant studies on DED and their orthodontic management. The available evidence, primarily from laboratory-based studies, is of low to moderate quality. The most challenging DED cases involve structural loss, especially in molars severely affected by molar-incisor hypomineralization (MIH) and certain types of amelogenesis imperfecta. To address the limitations of current research, well-designed clinical studies are needed to investigate various aspects of DED management, including pre-treatment of affected enamel, adhesive techniques for bracket bonding and removal, extraction of molars affected by MIH, and interdisciplinary collaboration among dental specialists. By advancing the understanding of DED and refining treatment strategies, orthodontists can improve the outcomes for patients with these conditions.

This in-vitro study aimed to evaluate the antibacterial efficacy and color changes induced by different chemical agents on the orthodontic aligners. The sample consisted of Invisalign® aligners materials and seven solutions were tested: sodium hypochlorite (HYP), sodium bicarbonate (BIC), neutral detergent (DET), chlorhexidine gluconate (CX), white vinegar (VIN) diluted in water (1:3), Corega Tabs® effervescent tablets (COR), and distilled water (DW, control group). The microbiological control was evaluated by analyzing cell proliferation (CFU/ml) and cell metabolism (AlamarBlue® test), and the VITA EasyShade® Advance spectrophotometer was used for color change analysis, using multiple Mann-Whitney tests. All solutions significantly reduced S. mutans biofilm (CFU/mL), except for the control group. The AlamarBlue® analysis showed a significant reduction in cell viability, except for the BIC solution (p=0.183). After 7 days, HYP showed significant color variation, compared to all the other solutions, except for the control group (p=0.095). After 14 days, BIC and CX showed significantly greater color variation than the control group (p=0.007). DET showed a large difference compared to BIC and CX (p=0.007), and a statistically significant difference compared to VIN and COR (p=0.015). The disinfectant solutions HYP, DET, CX, VIN, and COR significantly reduced the bacterial colonies of S. mutans and cellular metabolism. In addition, HYP, BIC, CX, and COR significantly affected the material color.

This single-blinded randomized control trial aimed to assess the effect of Low-Intensity Pulsed Ultrasound (LIPUS) on the duration of alignment and leveling stage, and to assess patients' pain and discomfort following the procedure. 30 participants (18-35 years) were recruited, of whom 22 were selected with Little's Irregularity Index of 1-6mm following a non-extraction protocol, and were randomly allocated into two groups using a lottery method. The test group underwent the LIPUS application for 20 minutes on days 0, 3, 5, 7, 15, and every 15 days until completion of alignment and leveling. The control group was subjected to a placebo protocol. Stage models were fabricated every 21st day and the duration taken for completion of alignment was recorded. The patient's satisfaction scale was documented using a questionnaire on a Visual Analog Scale. A statistically significant reduction was found in treatment time for alignment and leveling. A 22% reduction in total duration for alignment and leveling was observed (p=0.027). No appreciable difference in pain and discomfort was observed between the groups. The application of LIPUS for 20 minutes on days 0, 3, 5, 7, 15, and every 15 days until alignment completion showed a significant reduction in the duration taken for alignment and leveling of teeth.