Made available in DSpace on 2014-08-20T14:30:12Z (GMT). No. of bitstreams: 1 tese _Marcos_Antonio_Pacce.pdf: 838653 bytes, checksum: 3b5b150df1ebc16ec76a6a42a2e0c8a5 (MD5) Previous issue date: 2011-12-17 / The orthodontic treatment has been related to caries lesions development, since the devices used are biofilm retentive. This thesis aimed to evaluate the effect of ligation type and type of orthodontic bracket in the mineral loss and biofilm accumulation to these devices. To accomplish this goal, three studies were conducted. The first study consisted in a systematic literature review, where electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, ISI Web of Knowledge, TRIP, Scopus, and SciELO) were searched up to July 2011. Clinical trials or in situ studies that assessed the effect of types of brackets or ligatures on biofilm accumulation and/or enamel demineralization were selected. Non-controlled studies, in vitro studies, or studies not reporting on the established outcomes were excluded. The second study assessed the enamel demineralization around six types of brackets/archwire ligation combinations. In that study, microcosm plaque biofilms were grown in 24-well microplates on enamel discs for 14 days in artificial saliva. Growth condition comprised cariogenic challenge. The groups (n=10 per group) were: self-ligating brackets (SL); conventional brackets ligated with stainless steel wires (CW); conventional brackets (CE), brackets with hooks (HE), ceramic brackets (KE), and composite brackets (RE), all the four ligated with elastomeric rings. The biofilm formed around the brackets was collected and dry-weighted and the mineral loss around the brackets was determined by cross-sectional microhardness. The third study evaluated in situ the combinated effect of types of brackets and archwire ligation on enamel demineralization, on the accumulation and on microbiological composition of dental plaque. The study design was a modified in situ model, randomized, double-blind and split-mouth. Volunteers (n=17) wore palatal removable appliances containing enamel discs with bonded orthodontic brackets during 14 days. To provide cariogenic challenge, 20% sucrose solution was dripped 8x/day onto each disc. The four conditions under study were: CE; CW; HE; and SL. The biofilm formed around the brackets was collected for microbiological analyses and the mineral loss was determined by cross-sectional microhardness measurement. The systematic review results showed contradictions among studies, and a great methodology variation among them. The reviewed papers did not allow any conclusion about the effect of types of brackets and ligatures on caries lesions and biofilm accumulation. No differences were observed in vitro or in situ regarding biofilm biomass (P>0.05), except for the HE group wich presented lower biofilm accumulation in vitro (P<0.05). Lower demineralization was observed associated to self-ligated brackets, and brackets with more complex design promote higher demineralization than self-ligated brackets. The ligature methods also affected demineralization, and elastomeric rings are more prone to promote caries lesions then steel wires / O tratamento ortodôntico é relacionado com o desenvolvimento de lesões de cárie, uma vez que o aparelho constitui-se em fator de retenção do biofilme. Este trabalho de tese teve como objetivo avaliar o efeito do tipo de ligadura e tipo de bráquete ortodôntico na perda mineral e no acúmulo de biofilme adjacente a estes dispositivos. Para cumprir esse objetivo, três estudos foram realizados. O primeiro estudo consistiu em numa revisão sistemática da literatura, onde bancos de dados eletrônicos (PubMed, Embase, Cochrane Central Register of Controlled Trials, ISI Web of Knowledge TRIP, Scopus e SciELO) foram pesquisados até julho de 2011. Ensaios clínicos ou estudos in situ que avaliaram o efeito de tipos de bráquetes ou ligaduras no acúmulo de biofilme e/ou a desmineralização do esmalte foram selecionados. Estudos não controlados, in vitro, ou que não apresentaram os desfechos procurados foram excluídos. O segundo estudo avaliou a desmineralização do esmalte em torno de seis tipos de combinações de bráquetes / tipos de ligadura. Biofilmes foram formados a partir de inóculos de saliva (microcosmos) e cultivados em microplacas de 24 poços sobre discos de esmalte por 14 dias em saliva artificial, sob desafio. Os grupos (n = 10 por grupo) foram: bráquetes autoligantes (AL); bráquetes convencionais ligados com amarrilhos de aço inoxidável (CA); bráquetes convencionais (CE), bráquetes com ganchos (GE), bráquetes de cerâmica (KE), e bráquetes de compósito (RE), todos os quatro ligados com anéis elastoméricos. O biofilme formado em torno dos bráquetes foi coletado e teve seu peso seco determinado (mg). A perdam mineral adjacente aos bráquetes foi avaliada por microdureza de secção longitudinal. O terceiro estudo avaliou in situ o efeito combinado de tipos de bráquetes e tipos de ligadura sobre a desmineralização do esmalte, o acúmulo de biofilme e a sua composição microbiana. O estudo teve um desenho experimental randomizado, duplo-cego e de boca dividida. Voluntários (n = 17) usaram placas palatais removíveis contendo discos de esmalte com bráquetes ortodônticos durante 14 dias. Para fornecer desafio cariogênico, solução de sacarose 20% foi gotejada 8x/dia em cada disco. As quatro condições em estudo foram: CE; CA; GE e AL. Os biofilmes formados em torno dos bráquetes foram coletados para análises microbiológicas e a perda mineral foi determinada pelo método descrito acima. Os resultados da revisão sistemática mostraram divergência entre os estudos, com muita variabilidade metodológica entre eles. Os artigos revisados não permitem chegar a uma conclusão sobre o papél dos tipos de bráquetes ou ligadura no desenvolvimento de lesões de cárie ou no acúmulo de biofilme. Não foram observadas diferenças in vitro ou in situ quanto a biomassa do biofilme (P> 0,05), exceto para o grupo GE, o qual apresentou menor acúmulo de biofilme in vitro (P<0,05). Menor desmineralização foi observada associada à bráquetes autoligantes (P< 0,05). Bráquetes com um desenho mais complexo promovem maior desmineralização do que os autoligantes (P< 0,05). Os métodos de ligadura também afetaram a desmineralização, e anéis elastoméricos promovem lesões de cárie do que amarrilhos de aço (P< 0,05).

INTRODUCTION: Obtenir un résultat orthodontique idéal et un profil facial équilibré peut nécessiter un traitement combinant orthodontie et chirurgie orthognathique. Bien que les avantages esthétiques et fonctionnels de ces procédures soient évidents pour l'orthodontiste, il ne décide pas du traitement. Malgré les connaissances, les recommandations et la bienveillance de l’orthodontiste, le dernier mot revient au patient. Il peut donc évidemment refuser un traitement orthodontique chirurgical. L’obtention du consentement éclairé, avant de débuter le traitement, est une première étape décisive. Afin d’améliorer ce processus, il est essentiel de connaître et de comprendre davantage les facteurs décisionnels qui influencent le choix du patient face à un traitement orthodontique chirurgical. OBJECTIFS: Cette étude qualitative vise à déterminer les motifs pour lesquels les patients refusent le traitement orthodontique chirurgical lorsqu’il est l’option privilégiée par l’orthodontiste. Une meilleure compréhension du raisonnement et des motivations des patients permettra d’améliorer et de rendre l’approche du praticien davantage proactive afin de favoriser un réel consentement éclairé. MÉTHODES: Cette étude a été menée par entrevue verbale semi-structurée immédiatement suivant la consultation orthodontique initiale. Les entretiens individuels ont été enregistrés, retranscrits et analysés en continu. À l’aide du logiciel NVivo 12, les données ont été catégorisées par codage ouvert. RÉSULTATS: Quatre thèmes sont ressortis de cette étude : l'inconfort, la vision facultative du traitement par le patient, le changement d'apparence du visage et les contraintes à débuter le traitement. L'inconfort était un thème récurrent exprimé par tous les participants. CONCLUSION: Bien que les motifs contribuant au refus d'un traitement orthodontique chirurgical soient multiples, l’inconfort est un sujet qui interpelle tous les patients. Sans être forcément la raison principale menant au refus de ce type d'intervention, l'inconfort est un thème répétitif et à intensité variable dans la prise de décision. Il est particulièrement modulé par le vécu personnel du patient, mais aussi fortement influencé par celui de son entourage. Afin de favoriser un consentement plus éclairé, il est pertinent pour le praticien en orthodontie d’aborder ce sujet en profondeur au moment de la consultation. D’autres sujets devraient aussi être couverts selon les circonstances: la vision facultative du traitement par le patient, le changement d'apparence du visage et les contraintes. / INTRODUCTION: Achieving ideal orthodontic results and a balanced facial profile may require a combined orthodontic and orthognathic surgical treatment. Although the esthetic and functional advantages of these procedures are obvious to the orthodontist, patients may opt for a nonsurgical approach. Despite the knowledge, recommendations and good intentions of the orthodontist, the fact remains that the decision to proceed with treatment ultimately rests with the patient. Providing informed consent is a decisive step in the course of initiating treatment. To improve this process, it is essential to better understand the decision-making factors that influence the patient's choice for surgical orthodontic treatment. OBJECTIVES: The main objective of this study was to determine the motives that influence patients’ refusal of surgical orthodontic treatment even when it is the option of choice according to the orthodontist. Learning and understanding these factors can improve how we explain our treatment options by addressing information correctly, thus improving the process of obtaining informed consent. METHODS: This study was conducted using semi-structured verbal interviews immediately following the initial orthodontic consultation. Individual interviews were recorded, transcribed, and continuously analyzed. Using NVivo 12 software, an open coding analysis method was used. RESULTS: Four themes emerged from this study: discomfort, treatment viewed as elective by the patient, change in facial appearance and constraints to beginning treatment. Discomfort was a recurrent theme expressed by all participants. CONCLUSION: Although the reasons for refusing surgical orthodontic treatment are numerous, discomfort is a subject that concerns all patients. Without necessarily being the main reason for refusing surgical orthodontic treatment, discomfort is variable in intensity and a recurring theme in the patient's decision-making. It is particularly modulated by the patient's personal experience, but it is also strongly influenced by the experience of people around them. To promote a betterinformed consent, it is relevant for the orthodontic practitioner to cover this subject in depth during a consultation. Depending on the circumstances, other subjects should also be covered such as: the optional view of the treatment by the patient, the change in appearance of the face and the constraints.

AIM: To evaluate the prevalence of orthodontic problems and quality of life in relation to orthodontic problems among adolescent children in the city of Chennai, India. OBJECTIVES: To analyze the differences in the need for orthodontic treatment among children in the public and private schools; to analyze the need for orthodontic treatment among the various socioeconomic groups; to evaluate the Quality of Life (QoL) among the children; to analyze the relationship between Quality of Life (QoL) and the need for orthodontic treatment. METHODS: 200 children participated in the study, out of which 100 were from the private school and 100 from the public school from the city of Chennai, India. Two sets of questionnaires were used for the study, one was filled by the children and the other was filled by the researchers and trained dental assistants after doing a thorough dental examination and asking questions from the participants. This was carried out according to the recommendations of WHO oral health assessment. Statistical data was collected, recorded and analyzed using the software SPSS 17.0 for Windows. RESULTS: The private school children had more orthodontic problems than the public school children (49% and 44% respectively). The need for Orthodontic Treatment was the highest in children under the rich category (56.4%), followed by the children under the poor category (45.3%) and is least among the children under the average category (44.4%). The Quality of Life was... [to full text] / TIKSLAS: Įvertinti ortodontinio problemas ir perspektyvas atsižvelgiant į ortodontinio problemas tarp paauglių vaikų mieste Chennai, Indija. TIKSLAI: Analizuoti skirtumus reikalingas Ortodontinis gydymas tarp vaikų, viešąsias ir privačias mokyklas; analizuoti kad ortodontinio gydymo tarp įvairių socialinių ir ekonominių grupių; vertinti gyvenimo kokybę (QoL) tarp vaikų; išanalizuoti ryšį tarp gyvenimo kokybę (QoL) ir ortodontinio gydymo poreikį. METODAI: 200 vaikai dalyvavo tyrime, iš kurių 100 buvo privati mokykla ir 100 iš viešųjų mokyklų iš miesto Chennai, Indija. Vienų, ir klausimynų buvo naudojami tyrimo, vienas buvo užpildyti vaikų ir kitų buvo užpildyti mokslininkų ir apmokyti dantų padėjėjai po daro dantų nuodugniai ir užduoti klausimus iš dalyvių. Tai buvo daroma pagal PSO burnos sveikatos vertinimo rekomendacijas. Statistiniai duomenys buvo renkami, įrašytos ir analizuoti naudojant SPSS 17,0 programinė įranga Windows. REZULTATAI: Privačios mokyklos vaikai turėjo daugiau ortodontinio problemų nei valstybinių mokyklų vaikai (atitinkamai 49 % ir 44 %). Ortodontinio gydymo poreikis buvo didžiausias vaikams pagal turtingas kategorija (56.4 %), po to vaikai iki prastos kategorija (45.3 %) ir kas tarp vaikų iki vidutinės kategorijos (44.4 %). Gyvenimo kokybė buvo nustatyta, kad geriau tarp vaikų, privačios mokyklos nei valstybinėse mokyklose (90,6 % ir 89.0 % atitinkamai). Vaikams, kurie neturėjo nei gera gyvenimo kokybė turėjo mažai arba visai nėra ortodontinio kai... [toliau žr. visą tekstą]

Made available in DSpace on 2014-07-29T15:21:58Z (GMT). No. of bitstreams: 1 Dissertacao Iury Oliveira Castro.pdf: 1108480 bytes, checksum: 128afd0de2b97f12fc1f7b511b16af6f (MD5) Previous issue date: 2012-02-17 / Objective: To determine the frequency of apical root resorption in different tooth groups after the end of orthodontic treatment, detected by cone beam computed tomography. Methodology: Images of cone beam computed tomography of 30 patients who had Class I malocclusion and crowding were obtained before and after orthodontic movement. The treatment with fixed appliances was developed based on the Roth prescription. A total of 1256 dental roots were evaluated based on the measurement of linear length between root apex and incisal/cusp. It was an epidemiological, prospective, longitudinal and intra individual study. Results: The mean age of patients was 13 years, 11 were male and 19 female. One hundred percent of the patient presented teeth with apical root resorption, 46% of the roots avaluated was affected. The teeth showed higher extent of apical root resorption were upper lateral incisors, lower lateral, upper central, lower central, upper and lower first molars (p <0.05). By analyzing the roots individually, there was a high frequency of apical root resorption in maxillary central incisors (73%), maxillary lateral incisors (73%), mandibular central incisors (72%), mandibular lateral incisors (70%) and distal roots of mandibular first molar (63%). There was a low frequency of apical root resorption in the buccal roots of the maxillary second premolar (17%), distovestibular and palatine roots of maxillary second molar (18%) and distal roots of mandibular second molar (20%). The results showed that there was no association between frequency of resorption and gender (p> 0.05). The number of resorption did not vary with age when evaluated at age 11 to 16 years (p> 0.05). Conclusion: The apical root resorption was detected in 46% of the roots of teeth submitted to orthodontic treatment, diagnosed by cone beam computed tomography. The most affected teeth were central incisors, lateral and first molars. / Objetivo: Determinar a frequência de reabsorção radicular apical em diferentes grupos dentários após o término do tratamento ortodôntico identificada por meio de tomografia computadorizada de feixe cônico. Metodologia: Imagens de tomografia computadorizada de feixe cônico de 30 indivíduos, que apresentavam má oclusão Classe I e apinhamento, foram obtidas antes e depois da movimentação ortodôntica. O tratamento foi desenvolvido com aparelhos fixos com base na prescrição de Roth. Um total de 1256 raízes dentárias foram avaliadas com base na mensuração do comprimento linear entre ápices radiculares e incisais/cúspides. Resultados: A idade média dos pacientes foi de 13 anos, 11 eram do gênero masculino e 19 do feminino. Cem por cento dos pacientes apresentaram dentes com reabsorção radicular apical, com uma frequência de 46% de raízes afetadas. Os dentes que apresentaram maior extensão de reabsorção radicular apical foram incisivos laterais superiores, laterais inferiores, centrais superiores, centrais inferiores, primeiros molares superiores e inferiores (p < 0,05). Ao analisar as raízes individualmente verificou-se uma elevada frequência de reabsorção radicular apical em incisivos centrais superiores (73%), laterais superiores (73%), centrais inferiores (72%), laterais inferiores (70%) e raízes distais de primeiro molar inferior (63%). Verificou-se uma frequência baixa de reabsorção radicular apical em raízes vestibular do segundo pré-molar superior (17%), distovestibulares e palatinas de segundo molar superior (18%) e distal de segundo molar inferior (20%). Os resultados mostraram que não houve associação entre a frequência de reabsorção e gênero (p > 0,05). O número de reabsorção não variou com a idade quando avaliada a faixa etária de 11 a 16 anos (p > 0,05). Conclusão: A reabsorção radicular apical foi detectada em 46% das raízes de dentes submetidos a tratamento ortodôntico, por meio de tomografia computadorizada de feixe cônico. Os dentes mais afetados foram incisivos centrais, laterais e primeiros molares inferiores.

Contemporary conceptual models of health emphasize the importance of patient-based outcomes and recognize the complexity involved in their assessment. Various health conditions, personal, social, and environmental factors, are all thought to contribute to individual’s quality of life. However, the impact of orthodontic treatment on Oral Health-related Quality of Life (OH-QOL) outcomes in children has not yet been systematically studied. Hence, this research was planned to assess the effect orthodontic treatment has on pediatric OH-QOL outcomes. Further, the important moderational role of children’s psychological assets on OH-QOL reports is explored. Following completion of a preliminary study to confirm the psychometric properties of the Child Perception Questionnaire (CPQl1-14), the current two-phase study was undertaken. This consisted of a cross-sectional study examining the relationship among Self-Esteem (SE), malocclusion, and OH-QOL, and a longitudinal study examining the influence of orthodontics and children’s Psychological Wellbeing (PWB) on OH-QOL reports. This PhD dissertation is presented in the “Publishable Style”. The journals which hold the copyrights for the papers published from this thesis have given permission for the reproduction of the text and figures for this dissertation. The preliminary data confirmed that the CPQ11-14 is sensitive to change when used with children receiving orthodontic treatment. Our cross-sectional findings indicated that the impact of malocclusion on OH-QOL is substantial in children with low SE and identified SE as a salient determinant of OH-QOL in children seeking orthodontic treatment. Longitudinal data, on the other hand, detected significant improvement of OH-QOL outcomes after orthodontic treatment. As postulated, these improvements were most evident for the social and emotional domains of OH-QOL. However, covariate analysis emphasized the important role psychological factors play in moderating OH-QOL reports, as children with better PWB were more likely to report better OH-QOL regardless of their orthodontic treatment status. These results substantiate the validity of contemporary models of patient-based outcomes linking biological, personal, social, and environmental factors. Researchers and clinicians are encouraged to adopt this forward thinking approach when dealing with children with oro-facial conditions. Further studies with larger samples and longer follow-ups would be of value to expand on these findings.

Contemporary conceptual models of health emphasize the importance of patient-based outcomes and recognize the complexity involved in their assessment. Various health conditions, personal, social, and environmental factors, are all thought to contribute to individual’s quality of life. However, the impact of orthodontic treatment on Oral Health-related Quality of Life (OH-QOL) outcomes in children has not yet been systematically studied. Hence, this research was planned to assess the effect orthodontic treatment has on pediatric OH-QOL outcomes. Further, the important moderational role of children’s psychological assets on OH-QOL reports is explored. Following completion of a preliminary study to confirm the psychometric properties of the Child Perception Questionnaire (CPQl1-14), the current two-phase study was undertaken. This consisted of a cross-sectional study examining the relationship among Self-Esteem (SE), malocclusion, and OH-QOL, and a longitudinal study examining the influence of orthodontics and children’s Psychological Wellbeing (PWB) on OH-QOL reports. This PhD dissertation is presented in the “Publishable Style”. The journals which hold the copyrights for the papers published from this thesis have given permission for the reproduction of the text and figures for this dissertation. The preliminary data confirmed that the CPQ11-14 is sensitive to change when used with children receiving orthodontic treatment. Our cross-sectional findings indicated that the impact of malocclusion on OH-QOL is substantial in children with low SE and identified SE as a salient determinant of OH-QOL in children seeking orthodontic treatment. Longitudinal data, on the other hand, detected significant improvement of OH-QOL outcomes after orthodontic treatment. As postulated, these improvements were most evident for the social and emotional domains of OH-QOL. However, covariate analysis emphasized the important role psychological factors play in moderating OH-QOL reports, as children with better PWB were more likely to report better OH-QOL regardless of their orthodontic treatment status. These results substantiate the validity of contemporary models of patient-based outcomes linking biological, personal, social, and environmental factors. Researchers and clinicians are encouraged to adopt this forward thinking approach when dealing with children with oro-facial conditions. Further studies with larger samples and longer follow-ups would be of value to expand on these findings.