Objetivos: O objetivo deste estudo foi avaliar em adultos com perdas dos primeiros molares inferiores permanentes, as inclinações e angulações dentárias dos dentes adjacentes, bem como a espessura do rebordo após movimentação mesial de segundos molares para suprir a perda e verticalização dos segundos molares para reabilitação protética. Métodos: Foram selecionados 2 grupos de estudo. O Grupo Fechamento (GF) foi composto por 12 hemiarcos com ausência de primeiros molares permanentes e espaços variando entre 2 a 7mm, que foram tratadas ortodonticamente com fechamento do espaço. O Grupo Abertura (GA) foi composto por 14 hemiarcos com ausência de primeiros molares permanentes e espaços variando entre 7,1 a 12mm, que foram tratadas ortodonticamente com verticalização do segundo e terceiro molar e reabertura de espaço para reabilitação protética. Avaliou-se em modelos dentários digitais a angulação, a inclinação, a dimensão cérvico-oclusal e a espessura do rebordo. As comparações interfases e intergrupos foram realizadas com os testes t-pareado e t-independente respectivamente (p<0,05). Resultados: Houve melhora na angulação dos segundos molares inferiores tanto no GF quanto no GA, mostrando eficácia da mecânica em ambas as terapias; não houve alterações significantes nas inclinações vestibulolinguais dos dentes posteriores em ambos os grupos; a espessura do rebordo aumentou no GF e manteve-se constante no GA. Conclusões: As duas modalidades de tratamento demonstraram resultados adequados. A escolha do plano de tratamento deve ponderar a relação custo-benefício de cada caso, considerando-se a dimensão inicial do espaço, a presença dos terceiros molares, as condições periodontais iniciais, o tempo de tratamento e o custo financeiro. / Objectives: The aim of this study was to evaluate, in adults with loss of the first permanent molars, the inclinations and angles of adjacent teeth as well as the alveolar ridge thickness after mesial movement of second molars to close the space of the tooth loss and second molar uprighting to rehabilitation prosthetic. Methods: Two study groups were selected. The Group Closure (GC) was composed of 12 quadrants with no permanent first molars and edentulous spaces varying from 2 to 7mm, which were treated with orthodontic space closure. The Group Opening (GO) was composed of 14 quadrants with no permanent first molars and edentulous spaces varying from 7.1 to 12mm, which were treated with orthodontic uprighting of the second and third molars and reopening space for prosthetic rehabilitation. In digital dental models were evaluated the angulation, inclination, the cervical-occlusal dimension and alveolar ridge thickness. Interphase and intergroup comparisons were performed with with paired t-test and independent t-test, respectively (p <0.05). Results: There was improvement in the angulation of the mandibular second molars both in GC and GO, showing the mechanical efficiency in both therapies; there were no significant changes in buccolingual inclinations of the posterior teeth in both groups; the alveolar ridge thickness increased in GC and remained constant in GO. Conclusions: Both treatment modalities have demonstrated appropriate results. The choice of treatment plan should consider the cost-benefit of each case, taking into account the initial dimension of the space, the presence of third molars, initial periodontal conditions, treatment time and the financial cost.

A reabsorção radicular apical constitui um efeito indesejável, porém frequente, do tratamento ortodôntico e por este motivo, várias técnicas e materiais, tal como o aparelho autoligável Damon têm sido desenvolvido visando facilitar a prática clinica e diminuir esse efeito deletério. O propósito deste estudo foi comparar o grau de reabsorção radicular externa em casos tratados com o aparelho autoligável Damon e com o aparelho pré-ajustado convencional. A amostra constitui de 52 casos, sendo 25 do grupo 1, tratados com o aparelho autoligável Damon, com idade média inicial de 16,04 anos e idade média final de 18,06 anos e com tempo de tratamento médio de 2,02 anos; e 27 do grupo 2, tratados com o aparelho pré-ajustado convencional, com idade média inicial de 16,77 anos, idade média final de 18,47 anos e com tempo de tratamento médio de 1,70 anos. Foram avaliadas as radiografias periapicais dos incisivos superiores e inferiores ao final do tratamento ortodôntico. Os dois grupos foram compatibilizados quanto às idades inicial e final, tempo de tratamento, distribuição por gêneros, tipo de má oclusão e protocolo de tratamento sem extrações. A reabsorção radicular foi avaliada pelo escore de Levander e Malmgren. Os dados relacionados à reabsorção radicular foram comparados pelo teste não paramétrico de Mann-Whitney. Os resultados mostraram que não houve diferença significante nos graus de reabsorção radicular entre os dois grupos. Graus de reabsorção radicular semelhantes podem ser esperados ao final do tratamento com o aparelho autoligável Damon e o aparelho pré-ajustado convencional. / The apical root resorption is an undesirable effect, but frequent in orthodontic treatment and for this reason, several techniques and materials, such as self-ligated Damon appliance have been developed to facilitate clinical practice and decrease it. The purpose of this study was to compare the degree of external root resorption in patients treated with the self-ligated Damon appliance and the conventional preadjusted appliance. The sample comprised 52 cases, 25 in group 1, treated with the self-ligated Damon appliance, with mean initial age of 16.04 years, mean final age of 18.06 years, and mean treatment time of 2.02 years; and 27 in group 2, treated with the conventional preadjusted appliance, with a mean initial age of 16.77 years, mean final age of 18.47 years and mean treatment time of 1.70 years. It was evaluated the periapical radiographs of the maxillary and mandibular incisors at the end of orthodontic treatment. The two groups were matched regarding the initial and final ages and treatment time, gender distribution, type of malocclusion and treatment protocol without extractions. The root resorption was assessed by the score of Levander and Malmgren. Data related to root resorption were compared by the nonparametric Mann-Whitney test. The results showed no significant difference in the degree of root resorption between the two groups. Similar degrees of resorption can be expected after the treatment with the Damon self-ligated appliance and the conventional preadjusted appliance.

RESUMO Com o objetivo de avaliar as alterações dento-alveolares decorrentes da perda do 1 o molar permanente inferior, foi selecionada uma amostra de 111 radiografias panorâmicas, pertencentes a 27 homens e 84 mulheres, que haviam perdido, unilateralmente, o 1 o molar permanente inferior. A presença de todos os demais dentes inferiores, inclusive dos 3 os molares de ambos os lados, e a ausência de tratamento ortodôntico prévio eram critérios básicos para a inclusão da radiografia na amostra. A média de idade no momento da obtenção da radiografia foi de 19 anos e 8 meses (12 anos – 30 anos 11 meses). Indivíduos que relataram a perda recente do 1 o molar, ou seja,menos de 5 anos do tempo decorrido da perda, foram previamente removidos da amostra. Após as radiografias serem traçadas manualmente em papel ”utraphan”, foram obtidas, bilateralmente, medidas que definiam: as angulações dos dentes inferiores, o posicionamento ântero-posterior da dos 2 o e 3 o molares e do 2 o pré-molar, a altura do 3 o molar e do osso alveolar na área da perda. O lado com perda foi comparado ao lado sem perda (controle) através do teste “t” pareado ao nível de 5 % de confiabilidade. No intuito de obter informações sobre a influência do nível de formação do terceiro molar sobre as características morfológicas examinadas, a amostra foi dividida em dois grupos. O primeiro grupo era constituído por 51 indivíduos (média de idade de 24 anos e 5 meses) que apresentavam o terceiro molar completamente formado (CF). O segundo grupo foi formado por 60 indivíduos (média de idade de 15 anos e 7 meses) que apresentavam o terceiro molar ainda em formação. Os grupos foram comparados através do teste “t” para dados não pareados, ao nível de 5 % de confiabilidade. Os resultados obtidos revelaram que a perda unilateral do 1 o molar permanente inferior causou mudanças significativas na angulação e posicionamento de todos os dentes no lado com perda, quando comparados ao lado controle. Enquanto os 2 os molares inclinavam-se e deslocavam-se mesialmente, os incisivos, canino e os pré-molares inclinavam-se distalmente para a área da perda. A inclinação era maior, quanto mais próximo estivesse o dente do 1 o molar extraído. A inclinação mesial do 3 o molar só ocorreu, de forma significativa, quando eram isolados os indivíduos nos quais esses dentes já haviam sido completamente formados (CF). A análise da altura do osso alveolar revelou que ocorre uma reabsorção vertical significativa da área da perda, sendo essa reabsorção maior no grupo de indivíduos mais velhos (CF). Em síntese, pode-se concluir que a perda unilateral do primeiro molar permanente inferior provoca a movimentação de todos os dentes em direção à área do dente extraído, assim como uma progressiva reabsorção vertical do osso alveolar no espaço remanescente. / SUMMARY A sample of 111 panoramic radiographs (27 males and e 84 females), that had been submitted to unilateral extraction of lower 1 st permanent molar, was selected with the aim of evaluating dento-alveolar changes produced by the loss. No previous orthodontic treatment and the presence of all other lower teeth, including both 3 rd molars, were basic criteria to include patients in the sample. Mean age at panoramic examination was 19 years and 8 months (12 y – 30 y 11 m). Individuals that have reported recent 1 st molar loss (less than 5 years from the x-ray examination) were previously removed. After x-ray manual tracing, it was obtained bilateral measurements that provide tooth angulation of all lower teeth, antero-posterior displacement of 3 rd molars, 2 nd molars and 2 nd premolars, 3 rd molar height, and alveolar height at 1 st molar area. Measurements obtained at the extraction side were compared by paired student’s t test to the control side (no molar loss). In order to obtain information regarding the influence of the 3 rd molar development stage on the morphologic variables examined, sample was divided in two groups, according to 3 rd molar developmental stage at the control side. 60 individuals (mean age 15 y 7 m) that had 3 rd molar not completed developed (EF)composed the first group. The second group was constituted by 51 individuals (mean age 24 y 5 m) that had the 3 rd molar completed developed (CF). These groups were compared by student’s t test. Findings obtained showed that unilateral 1 st molar loss produced significant changes in mesio-distal angulation and antero-posterior positioning of all teeth located at the loss side compared to control side. While lower 2 nd molars inclined and displaced mesialy, premolar, canine and incisors inclined and displaced distally to extraction space. The major tooth movimentation were observed close to the extracted 1 st molar area. Mesial inclination of the 3 rd molar occurred significantly only when subjects that had 3 rd molars completely developed (CF) were examined. Alveolar height examination revealed that a vertical alveolar resorption had occurred significantly at the extraction site. This resorption was larger in individuals that had 3 rd molars completely developed (CF). In resume, it may be concluded that unilateral extraction of the lower 1 st permanent molar produces a significant movimentation of all lower teeth through the site extraction, as well as a progressive vertical resorption at the 1 st molar space remaining.

Orientador: Daniela Leal Zandim-Barcelos / Resumo: A movimentação dentária ortodôntica em pacientes adultos com histórico de doença periodontal requer um planejamento complexo, devido à reabsorção óssea, e a dificuldade de se obter uma ancoragem satisfatória por consequência da perda de elementos dentários. O objetivo deste trabalho foi avaliar as alterações longitudinais no perfil microbiológico e nos parâmetros clínicos periodontais de incisivos centrais superiores com periodonto reduzido durante e após término do movimento de intrusão dentária. Vinte pacientes com doença periodontal foram selecionados de acordo com os critérios do estudo. Estes pacientes deveriam apresentar incisivos centrais superiores vestibularizados e extruídos com perda de inserção ≥ 5 mm e indicação de intrusão dentária. Todos os sítios com atividade de doença periodontal receberam raspagem e alisamento radicular (RAR) e para o tratamento ortodôntico ser iniciado, os incisivos centrais superiores deveriam apresentar estabilidade no nível clínico de inserção após 90 dias do término do tratamento periodontal ativo. Os parâmetros clínicos Índice de placa (IP), Índice Gengival (IG), profundidade de sondagem (PS), nível clínico de inserção (NCI), recessão gengival (RG), sangramento à sondagem (SS) e tamanho de coroa clínica (TCC) foram avaliados antes do procedimento de RAR, no início do movimento de intrusão (T1- Baseline), durante o movimento de intrusão (90 e 180 dias), imediatamente após o término da intrusão ortodôntica (T2), 90 e 180 dias após o tér... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Orthodontic tooth movement in adult patients with a history of periodontal disease requires complex planning, due to bone resorption, and the difficulty of achieving satisfactory anchorage as a result of loss of dental elements. The objective of this study was to evaluate longitudinal changes in microbiology and clinical periodontal parameters of upper central incisors, in patients with reduced periodontium, before, during and after orthodontic intrusion. Twenty patients with periodontal disease were selected according to the study criteria. These patients should have vestibularized and extruded upper central incisors with insertion loss ≥ 5 mm and indication of dental intrusion. All sites with activity of periodontal disease received scaling and root planing (RAR) and for orthodontic treatment to be started, the upper central incisors should have stability in the clinical level of insertion after 90 days of the end of active periodontal treatment. Clinical parameters Plaque index (PI), Gingival index (GI), probing depth (PD), clinical level of insertion (CLI), gingival recession (GR), probing bleeding (PB) and clinical crown size (CCS) were evaluated before the RAR procedure, at the beginning of the intrusion movement (T1- Baseline), during the intrusion movement (90 and 180 days), immediately after the end of the orthodontic intrusion (T2), 90 and 180 days after the end of the intrusion treatment. Sample collections of gingival crevicular fluid (GFC) were performed during t... (Complete abstract click electronic access below) / Mestre

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / External apical root resorption (EARR) is a common complication of orthodontic treatment. Genetic factors account for approximately 50% of the variation in EARR. Data have indicated variation in histological root resorption associated with orthodontic force (RRAOF) among different inbred strains of mice. Differences in expression of RANKL and OPG were investigated in two strains of mice with different susceptibility to RRAOF using irnmunohistochemistry. Increased localization of RANKL was detected in the tissues surrounding the root of the susceptible strain compared to the resistant strain and the controls. In contrast, increased localization of OPG was found in the tissues surrounding the roots in the resistant A/J strain compared to the susceptible DBA/2J strain. We conclude that differences in the expression of these key bone resorption mediators play a role in determining RRAOF susceptibility. Changes in serum TRAP 5b level in response to orthodontic force were investigated among female A/J, DBA/2J and BALB/cJ mice. The three strains differed in their TRAP positive cell numbers as well as their serum TRAP 5b level at baseline and when treated. A significant increase in the serum TRAP 5b level with treatment was only detected in the RRAOF susceptible DBA/2J strain, and not in RRAOF resistant strains. Our analysis indicates that differences in osteoclast/odontoclast activity play a role in susceptibility to RRAOF that is genetically determined. Serum TRAP 5b levels have a potential role in screening for individuals with greater susceptibility to root resorption. RRAOF was determined for male and female mice of the A/J, DBA/2J and BALB/cJ strains, as well as A/J x DBA/2J and A/J x BALB/cJ crosses. Sex differences were observed among the BALB/cJ strain only, with females more resistant to RRAOF when compared to males. Fis from the A/J x BALB/cJ cross were resistant suggesting that the A/J have dominant resistance alleles, while Fis from the A/J x DBA/2J cross had RRAOF intermediate between their parental A/J and DBA/2J mice, suggesting a polygenic trait. We concluded that the mode of inheritance of RRAOF in mice was polygenic in nature.

Indiana University-Purdue University Indianapolis (IUPUI) / According to one theory of root resorption, occlusal trauma during orthodontic tooth movement damages the cementum covering the root dentin. The body detects the exposed dentin and seeks to remove it, and the result is root resorption. This experiment will explore an aspect of this theory by quantifying the amount and location of damage in mechanically fatigued teeth. Nine dog mandibles were sectioned at the mandibular symphysis. Each half was mounted in orthodontic resin with the incisors upright and exposed. The block was inserted into a jig and placed into a servohydraulic mechanical testing machine. The left central incisor was fatigue loaded with a 2Hz, 10-90 N sinusoidal force for 100,000 cycles (approximately 14 hours). The right central incisor served as the control. Both specimens were scanned with a micro-CT unit, stained with basic fuchsin, and then sectioned along the sagittal plane. Because the experimental and control specimens were stained before sectioning, only microdamage due to the loading process would be evident in the sections. Microdamage which occurred during the sectioning process would not be stained. Central sections through the long axes of the samples were examined for the presence of microdamage with a light microscope and a micro-CT unit. Based on preliminary findings, two types of staining patterns were measured and recorded. The first was called "diffuse stain" and consisted of large stained areas in the dentinal tubules. Diffuse stain was not associated with any visible features at the dentinocemental junction. The second type of staining pattern was called "stained defects." Stained defects were stained irregularities at the dentinocemental junction. For statistical analysis, the roots were divided into buccal-cervical, buccal-middle, buccal-apical, lingual-cervical, lingual-middle, and lingual-apical regions. Comparisons between the fatigued and non-fatigued teeth for differences in area, length, and depth were made under the generalized estimating equation (GEE) framework applied to normally-distributed data. Because the measurements were not normally distributed, a rank transformation of the measurements was performed before conducting the analyses. Comparisons between the fatigued and non-fatigued teeth for differences in presence or absence of stain or defects were made using Cochran-Mantel-Haenszel tests. Repeatability of the measurements was assessed using intraclass correlation coefficients (ICCs), paired t-tests, and Bland-Altman plots. The ICC's ranged from 0 .85 to 1.00, thus making the repeatability of the measurements generally very good. The statistical analysis showed there were no significant differences between the experimental and control teeth for stained defects or diffuse staining for length, depth, or area measurements. However, analyses comparing the distribution of stained defects and diffuse stain within the control and experimental specimens showed significant differences in the distribution of stained defects within the experimental specimens. In the experimental specimens, the stained defects were distributed in a gradient, with the most in the apical region and progressing to the least amount in the cervical region. In the control specimens, there was only a difference in the stained defects between the cervical and apical regions. This distribution is consistent with the biomechanical model which shows increasing stress moving from the cervical region towards the apex. These results show that the test and control specimens differed in how the stained defects were distributed throughout the root, even though there were no differences in the amount of staining between the control and experimental specimens. Whole tooth and histologic slides were scanned with the micro-CT unit, but the dentinocemental junction could not be delineated enough to make any measurements. No data could be collected regarding microdamage in this area using the micro-CT unit. It was recommended that future studies use a tomography unit with better resolution, use a larger samples size, employ a contrast agent when trying to visualize microdamage with the micro-CT unit, and incorporate a way to measure the intensity of the staining in addition to the location and size.

Indiana University-Purdue University Indianapolis (IUPUI) / The current movement in dentistry is to provide treatment that is evidence-based rather than opinion-based. Unfortunately, there is a lack of evidence for most orthodontic appliances. Much work has been done to find the appropriate load system to move teeth, but research has only been done with laboratory techniques that may not be applied clinically. Ideally, appliances should be tested in all three dimensions with techniques (e.g. type of ligation) that replicate clinical procedures. This can be accomplished with a new patented technology, the orthodontic force tester (OFT). The OFT allows an entire arch with brackets and a full arch wire to be set up while measurements are made on target teeth. With the OFT, appliances can be tested to ascertain if they provide the prescribed load system, and if not, then modify them or develop new ones. In this experiment two different commercially available prefabricated closing loop arch wires (keyhole and teardrop) were tested with variations in gable bends, interbracket loop position, and activation. The application being tested is closing space between a lateral incisor and canine in a first premolar extraction case after the canine has been retracted. While the trend shows that the keyhole loop produces higher overall force the two loops are not significantly different in the forces or moments that they generate. The one exception is that the keyhole loop produces higher lingual forces at the canine when the loop is in the mesial position. Also, few wire configuration were able to produce M/F sufficient to translate teeth. The wire configurations that can provide the proper load system to translate teeth in the lingual direction at the incisor were in the mesial position and had second order gable bends at the alpha position. The loop design had little effect on the M/F ratios.

Indiana University-Purdue University Indianapolis (IUPUI) / Several studies have shown endosseous implants placed in areas of thick cortical bone to be an effective means of anchorage in complex orthodontic cases. The purpose of this study was to examine the viability of endosseous implants as orthodontic/orthopedic anchorage when placed in this cancellous bone. Eighteen 6-month-old male rabbits were used and stratified into three groups of six animals. Two implants placed (bilaterally) in the dorsal surface of the nasal bones. After a 12-week healing period, the control group (C) had a passive spring placed between the implants, and the 1 Newton constant group (1 NC) received a spring that delivered a constant compressive load of 1N. A 1N load was applied to the progressive load group (3NP) and sequentially increased to 3N over the course of the study. Bone labels were administered throughout the experiment at designated time intervals to provide quantification of the physiologic activity. Following histologic processing, analyses were conducted on midfrontal sections using microradiography and fluorescent microscopy. The implants were divided into three regions: supraflange, coronal, and apical. Within each region the percent woven and lamellar bone was recorded as well as the percent bone in contact with or near the implant surface. Remodeling activity was observed by using fluorescent bone labels. In the sections analyzed using fluorescent microscopy, the regions were further subdivided into zones. Using the bone label data, bone was categorized as old bone, new woven bone, new lamellar bone and marrow space. Within animal, paired t tests revealed no significant difference between right/left implants. Data was pooled and an ANOVA run to test for difference between groups. Few significant differences were seen. Student Newman-Keuls sequential range tests were used to test between region and zone. The coronal region showed trends of more bone overall in the 1NC and the 3NP load groups p < 0.10. The apical region had less bone overall. The fluorescent data showed few significant differences between groups; however, the coronal region showed trends of more bone overall. A RAP effect was observed in the zonal analysis for new lamellar bone. Sutural remodeling was observed at the cortical plate over the nasal suture. A significant trabecular response was not seen in this study; however, the implants in the experimental groups remained stable throughout the study possibly due to the implant design. It was concluded that implants placed in thin cancellous bones are suitable for use as orthodontic/orthopedic anchorage.

Indiana University-Purdue University Indianapolis (IUPUI) / Orthodontic closing loops offer an efficient way to control the moment to force ratios (M/F) delivered during space closure. The triangular loop is often used in the Graduate Orthodontic Clinic at the Indiana University School of Dentistry. Previous studies on the triangular loop were concerned with various loop geometries. The present project was designed to study the triangular loop in a clinically realistic experimental set up. Compared to the previous studies, three major changes were implemented: instead of two coplanar brackets, the current study employed a bracketed typodont arch (1) the effects of loop locations (2) and different interbracket distances were considered (3). The measured moment and forces reflect considerable differences in the systems due to the new experimental set up. As in previous studies, the triangular loops were fabricated from 0.016 X 0.022- inch stainless steel wire. The loops were equilateral triangles with 8 mm sides, ligated to the arch wire by elastomeric rings. There were 4 loop locations: location 1 was at 1.2 mm away from the mesial bracket; location 2 was at 3 .2 mm away from the distal bracket; location 3 was centered in the middle of the original interbracket distance; location 4 was located 2.6 mm away from the mesial bracket. There were three interbracket distances (IB). The original IB (IBl) of 12.6 mm was decreased by 3 mm (IB 2) and by 6 mm (IB 3). The loops were activated by 1.6 mm and 3.3 mm. Force and moment components were measured along three mutual perpendicular axes (x, y, and z) corresponding to the buccolingual, mesiodistal, occlusogingival axes respectively. Comparisons of Mx/Fy and Mz/Fy at the mesial and distal, by three activation levels, three interbracket distances, and four locations, and all interaction effects, were performed using a mixed design repeated measures ANOV A procedure. The General Linear Model (GLM) procedure for unbalanced designs was used because not all interbracket distances could be accommodated with all loop locations. Activation distance was the within specimen repeated factor. Loop location and interbracket distance were the between specimen factor. It was theorized that the location of the triangular loop, as well as the interbracket distance, have a considerable effect on the generated M/F. The Null Hypothesis was that there are no significant differences (p > 0.05) in the M/F ratios generated by the triangular loop as the loop position changes relative to the brackets, and there are no significant differences (p>0.05) in the M/F ratios generated by the triangular loop as the interbracket distance becomes shorter with space closure. Statistical significant interactions were found for Mx/Fy and Mz/Fy at location 2, for all activations, at both the mesial and distal measures. Therefore we rejected the first part of the Null Hypothesis (no differences as the loop location changes), and accept the second part (no differences as the interbracket distance shortens). We were able to see clear trends at all loop locations, as well as interbracket distances, and draw useful clinical implications. We found that the mesial closing forces are quite small when compared to those at the distal. We attributed this discrepancy to the U shape geometry of the continuous arch wire technique. We observed that if closing loops are delivered with no activation, then counterproductive M/F ratios are produced. Our data also indicated that anchorage becomes more critical as the interbracket distance shortens. Finally, we determined that wire tie ligation for prevention of rotation along the long axis of the tooth is especially important for the lateral incisor.