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Introduction: The complexity of treating impacted maxillary canines varies based on their angulation and position within the dental arch. The aim of this research was to compare the mesiodistal angulation of maxillary canines according to their impaction sector., Methods: This cross-sectional study evaluated 229 impacted maxillary canines in 171 panoramic radiographs from two private radiology centres in Uruguay and Chile of individuals of both sexes aged 11 years and older with impacted maxillary canines. The radiographs were taken with two panoramic radiography equipment. All the images were evaluated using Planmeca Romexis® software. Two investigators were trained and calibrated to perform all the measurements at two measurement times. The Ericson and Kurol method was used to classify the impaction sector into five sectors and the Wardorf method was used to measure the mesiodistal impaction angle and, finally, the level of impaction was measured with respect to the root of the lateral incisor. Student t-test, Anova and multiple linear regression were used. P<0.05., Results: The impaction angle of sectors 1 and 2 was (70.03°±9.65°) and of sectors 3, 4 and 5 it was 52.21°±16.60° (P<0.001) while at the cervical level of the lateral incisor root it was 74.15°, 68.04° at mid-level and 57.39° at the apical level (P<0.001). The impaction angle decreases 13.02° in sectors 3, 4 and 5 (P<0.001), for each year the impaction angle decreases 0.30° (P=0.001), and as the level of impaction becomes more apical the impaction angle decreases 7.46°., Conclusions: Impacted maxillary canines are more horizontal the closer they are to the midline or the higher the level of impaction. Likewise, this horizontality tends to increase over time. All these considerations should be taken into account by orthodontists when planning their treatments., (Copyright © 2025 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Treatment of impacted upper incisors in a labially inverted position is challenging for orthodontists, and its prognosis has not been established in the literature. Thus, this systematic review aimed to determine the effectiveness and side effects of orthodontic traction of impacted maxillary incisors in a labially inverted position., Methods: A comprehensive search was conducted in multiple databases, including MEDLINE (via PubMed), Scopus, Embase, Science Direct, and LILACS, up to June 30, 2024. Initially, 1640 articles were identified, and after applying specific selection criteria, 11 articles were selected for full-text evaluation. Following the review, only six studies were deemed relevant, comprising one before-and-after study, two longitudinal retrospective studies, and three cross-sectional studies. Newcastle-Ottawa and Risk of Bias (ROB-2) tools were used to assess the risk of bias in the selected studies., Results: The average duration of traction for maxillary labially inverted impacted central incisors ranged from 8.60±1.26months to 18±6.0months, with all cases being successfully treated. Following traction, the clinical crown height of the incisors was significantly higher compared to the control group (P<0.01). Similarly, the root length of the impacted incisors after traction was shorter in the impaction group (approximately 2mm) compared to the control group. Likewise, the thickness of the alveolar bone varied among different studies. Some authors noted that the treatment group had a smaller thickness (about 0.5mm) compared to the control group (P<0.05), while other authors found similar thickness after treatment., Conclusions: Although there are few reported studies with a low risk of bias, it is clear that it is possible to successfully treat labially inverted impacted maxillary central incisors with apparently few side effects. Following traction, the clinical crown height of these incisors increased, while the root length was shorter than their normally erupted contralateral teeth., (Copyright © 2024 CEO. Published by Elsevier Masson SAS. All rights reserved.)

In this article by Martinez-Ccahuana and colleagues (J Clin Exp Dent. 2022;14(11):e897-902), there is an error in the authors of the manuscript. The correct author list is: Lizbeth Martinez-Ccahuana, Evelyn Álvarez-Vidigal, Luis-Ernesto Arriola-Guillén, Denisse Aguilar-Gálvez. References 1. Lizbeth Martinez-Ccahuana, Evelyn Álvarez-Vidigal, Luis-Ernesto Arriola-Guillén, Denisse Aguilar-Gálvez. Effect of pediatric mouthwashes on the color stability of dental restorations with composite resins. In vitro comparative study. J Clin Exp Dent. 2022;14(11):e897-902. PMid: 36458028 PMCid: PMC9701350., (Copyright: © 2024 Medicina Oral S.L.)

Background: Mandibular asymmetry is more common than previously thought. The purpose of this study was to determine the prevalence of mandibular, condylar and ramus asymmetry by means of the Habets index using panoramic radiographs obtained from adult individuals., Material and Methods: This cross-sectional study evaluated 210 panoramic radiographs performed in adults attending a private referral radiology center in Lima, Peru. Radiographs of both genders were considered, including permanent dentition and of good quality. A trained and calibrated evaluator assessed mandibular, condyle and ramus height using the Habets method, considering asymmetry when the difference between the two sides was greater than 3%. Fisher's exact test, the paired Student's t-test and finally binary logistic regression were used to determine the characteristics of the asymmetries., Results: Mandibular asymmetry was present in 39.5%, condylar asymmetry in 81.4% and mandibular ramus asymmetry in 48.6%, with no differences between genders ( P >0.05). Only women showed a difference between the two sides in mandibular ( P =0.008), and condylar height ( P =0.013), although multivariate analysis showed neither gender nor age to have any significant influence on the occurrence of mandibular, condylar or ramus asymmetries., Conclusions: The prevalence of mandibular, condylar and ramus asymmetries in the sample evaluated was significant, although most of these asymmetries can be considered mild, given that the highly sensitive Habets index classifies any difference greater than 3% as asymmetry. These asymmetries, although most of them could be clinically not very noticeable, should be considered when planning treatments. In addition, neither gender nor age was found to significantly influence the occurrence of these asymmetries. Key words: Asymmetry, condyle, mandible, orthodontics., Competing Interests: Declared none., (Copyright: © 2024 Medicina Oral S.L.)

Background: This study aimed to determine the percentage of perfect and acceptable coincidence between the facial and maxillary dental midlines in individuals from Peru., Material and Methods: This was a cross-sectional study of a group of Peruvian individuals gathered from private offices in Lima, Peru, from January to June 2024. A total of 279 patients (133 males and 146 females) aged between 18 and 30 were included. We selected patients with permanent teeth up to their second molars, while those with gaps between their front teeth, ongoing or previous orthodontic treatment, or any craniofacial anomalies were excluded. Using a professional camera, we took frontal photographs of the participants at rest and while smiling. The facial morphological index was used to classify facial biotypes into three categories: mesofacial, dolichofacial, and brachyfacial. We then used the PowerPoint program to analyze perfect and accepted coincidence (deviation to either side of up to 2 mm) between the facial and dental midline. The data was analyzed by chi-square tests and binary logistic regression (p>0.05)., Results: Perfect coincidence of the dental midline was present in 23.3% of the cases, while an accepted coincidence was observed in 95.7% of the individuals. When considering facial structure, the percentage of alignment of the maxillary dental midline (perfect or accepted) with the facial midline did not show a significant association ( p =0.145, p =0.870, respectively). Furthermore, there were no significant differences in the percentage of alignment between men and women ( p =0.241 for perfect coincidence, p =0.322 for accepted alignment)., Conclusions: Most Peruvian individuals assessed had an accepted coincidence (up to 2 mm) between the facial midline and the maxillary dental midline, although it is not always perfect. In these cases, orthodontic treatment is needed for optimal occlusal relationships and stable facial esthetics. Key words: Esthetics, Facial midline, maxillary dental midline, Peruvian., Competing Interests: Declared none., (Copyright: © 2024 Medicina Oral S.L.)

Background: Digital transformation (DT) involves introducing digital technologies into business models in all areas. This research aimed to evaluate the level of implementation of DT using the digital health indicator in private radiology centers in Lima, Perú., Material and Methods: Forty-five randomly selected radiology centers included in a database of 50 registered centers were evaluated. The inclusion criteria were having a web domain and institutional email address. They were digitally surveyed using a digital survey (HIMSS DHI Rapid) measuring four dimensions: interoperability, governance and workforce, predictive analytics, and person-enabled health. These indicators allowed determination of the digital transformation level of a radiological company. The level of implementation was measured quantitatively on a scale from 0 to 400, and the Kruskal Wallis test (p>0.05) was used to compare DT according to the geographical location of the centers., Results: The digital health indicator obtained was 60.24 ± 43.14 out of 400 achievable points. The dimensional analysis in terms of interoperability was 24 ± 18.09, followed by governance and workforce at 23.44 ± 18.58, person-enabled health at 18.73 ± 15.63, and finally, predictive analysis at 16.18 ± 13.51. No significant differences were found in health indicator dimensions according to the geographical location ( p >0.05)., Conclusions: DT in maxillofacial radiology centers in Lima is at an initial level. Radiology centers should take this situation into account to have relevant information for making diagnostic and treatment decisions and to provide better preventive health policies to benefit the population. Key words: Digital transformation, digital health indicator, dental radiology., Competing Interests: Declared none., (Copyright: © 2024 Medicina Oral S.L.)

Background: In the search for alternatives to increase the bond strength of brackets, when necessary, this study proposes to apply the enamel deproteinization protocol to eliminate the proteins in the surface enamel to achieve better etching patterns and thereby increase bond strength. The aim of this study was to evaluate the effect of sodium hypochlorite as a deproteinizing agent on the bond strength of metal brackets., Material and Methods: Forty bovine teeth were randomly and equally divided into two groups. The experimental group (n=20) underwent a deproteinization treatment with sodium hypochlorite at 5.25% for 60 seconds prior to acid etching of the enamel with 37% phosphoric acid and bracket bonding with Transbond XTTM resin. The control group (n=20) underwent enamel etching with 37% phosphoric acid and bracket bonding with Transbond XTTM resin. Shear strength and the adhesive remnant index were evaluated and the Students t and Chi-square tests were used ( P <0.05)., Results: The bond strength values of the control group (27.72±6.42 Mpa) were not significantly lower compared to the experimental group (29.21± 7.96 Mpa) ( p =0.259). The adhesive remnant index showed a similar behavior in both groups, with the amount of adhesive remaining on the enamel being less than 50% in most samples of both the control and experimental group., Conclusions: Deproteinization treatment of bovine tooth enamel with 5.25% sodium hypochlorite for 60 seconds prior to enamel acid etching does not improve the bond strength of a resin in orthodontic bracket bonding. Key words: Deproteinization, sodium hypochlorite, bracket bonding, orthodontics., Competing Interests: Declared none., (Copyright: © 2024 Medicina Oral S.L.)

Introduction: We aimed to compare alveolar morphometry in young adults with agenesis of the upper lateral incisor versus the side without agenesis and versus matched controls., Material and Methods: In this observational retrospective study, cone beam computed tomography scans were obtained of 36 upper hemiarches from young adults aged 15 to 30 years. The hemiarches were distributed into three groups: group 1: 12 upper hemiarches presenting agenesis of the upper lateral incisor; group 2: 12 upper hemiarches from the opposite side without agenesis of the upper lateral incisor (control group 1); and group 3: 12 upper hemiarches without agenesis of the upper lateral incisor matched for age and sex with respect to the affected group (control group 2). A trained and calibrated investigator performed all the alveolar measurements at two different times, including sagittal, coronal and axial slices of each hemiarch. Paired Student's t-tests, Chi-square and repeated measures ANOVA with Bonferroni correction were used, (P<0.05)., Results: Apical mesial evaluation of group 1 (4.22±1.19mm) was significantly lower (P<0.001) than that of groups 2 (6.72±1.17mm) and 3 (7.58±1.67mm). Apical distal evaluation also showed differences (P<0.001) among the three groups, with the dimension being smaller in group 1 with agenesis (4.53±1.14mm), followed by group 2 without agenesis (6.23±1.55mm) and the healthy control group 3 (7.73±1.71mm)., Conclusions: Lateral incisor agenesis significantly reduces the alveolar dimensions of the affected area. In cases of unilateral agenesis, the unaffected side also shows sequelae, with decreased dimensions compared to cases without agenesis. This condition should be taken into account when making therapeutic decisions regarding rehabilitation with implants or canine replacement., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: Mandibular canine impaction is infrequent in dental eruption anomalies and treatment is very challenging. The aim of this multicenter retrospective panoramic study in Latin America was to evaluate panoramic radiographic imaging characteristics of mandibular canine impaction (impaction area, mandibular base contact, transmigration, impaction height and sex) and their associations., Material and Methods: This cross-sectional study evaluated 212 digital panoramic radiographs from three radiological centres in Tingo Maria (Peru), Bogota and Tunja (Colombia). The study included children of both sexes with impacted mandibular canines. Mandibular alpha angle, contact with mandibular basal bone (MBB), impacted sector according to 10 sectors with an adaptation of the Ericson and Kurol method, presence of transmigration and the impacted height were measured and the relationship among these measures was analyzed. Fisher's exact test, Chi-square and binary logistic regression were used. (P<0.05)., Results: The mandibular canine impaction showed contact with the MBB (32.08%), dental transmigration (36.79%), mainly located at an apical (40.09%) and sub-apical (36.79%) level. Transmigration mainly occurred in sectors 6 (33.30%) and 10 (25.60%) (P<0.001). It was found that for each year of increase in age, the possibility of contact with the MBB decreased (β=0.89, P=0.010), and as the alpha angle increased by one degree the probability of contact with the MBB decreased (β=0.97, P=0.001) and the probability of transmigration increased (β=1.05, P<0.001)., Conclusions: One third of the impacted canines were in contact with the MBB, while another third presented dental transmigration and were mainly located apically and subapically of the incisor roots. These imaging features should be taken into account when planning orthodontic treatment., (Copyright © 2024 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Background: Aligners are an alternative that are currently being widely used in orthodontic treatment, however, post-treatment relapse following aligner versus conventional treatment has not been compared. The objective of this study was to compare post-treatment relapse of orthodontic treatment with dental aligners versus conventional fixed orthodontics through a systematic review., Material and Methods: An exhaustive search was carried out in the MEDLINE (via PubMed), EBSCO, SCOPUS and EMBASE databases up to September 30, 2023. A total of 522 articles were found and after applying the selection criteria, the full texts of 24 articles were chosen for evaluation. At the end of the evaluation, only 3 studies were considered, two observational studies and one randomized clinical trial. The Newcastle Ottawa and Risk of bias (ROB-2) tools were used to assess the risk of bias., Results: Of the three studies, only one (evaluated three years post-orthodontic treatment) identified significant differences in the frequency of relapse following total, maxillary and mandibular anterior alignment using conventional orthodontics. The other two studies (one evaluated at six months and the other two years post-orthodontic treatment) did not show statistically significant differences ( p >0.05). In addition, the two latter studies reported slight relapse related to detachment of the fixed retainer., Conclusions: The current evidence available indicates a lack of well-designed studies comparing post-treatment orthodontic relapse following the use of dental aligners versus conventional fixed orthodontic treatment, and the studies published to date have a high or moderate risk of bias. However, there are apparently no significant differences in frequency of relapse between the two types of treatment, suggesting similar stability results. Nonetheless, more well-designed studies are required to confirm this observation. Key words: Aligners, brackets, relapse, orthodontic., Competing Interests: None declared., (Copyright: © 2024 Medicina Oral S.L.)

This single-center trial aimed to longitudinally compare the oral health-related quality of life (OHRQOL), adaptation and discomfort during anterior open bite (AOB) treatment with lingual spurs and build-ups (SBU) versus spurs only (S) approaches. Children (7-11 years) with AOB were randomly allocated into two treatment groups (SBU or S). The Child Perception Questionnaire (CPQ 8-10 ) was applied 1 and 12 months after installation of the appliances. Questionnaires evaluating functional adaptation and discomfort during the first month of treatment were also applied. A visual analog scale (VAS) was used in these questionnaires. Generalized mixed models were used for analyzing OHRQOL and discomfort data. Generalized linear models were used to assess adaptation outcomes (α = 0.05). The SBU group included 24 patients (7 males and 17 females; mean age 8.2 years) and the S group included 25 patients (11 males and 14 females; mean age 8.3 years). Regardless of the treatment type, overall OHRQOL scores at 12 months were 0.69 times those recorded at 1 month after the appliances installation (i.e., ~ 31% reduction; exp (β) = 0.69; 95% CI: 0.55, 0.88). A significant interaction between treatment and time was detected for the 'functional limitations' domain. For this domain, a significant improvement from the first to the twelfth month was observed in the S group (P < 0.001). Patients in both treatment groups showed similar and easy adaptation to the appliances. Independent of the type of treatment, tongue-related discomfort decreased over time. One week and one month after the appliance's delivery, the discomfort scores were 0.19 (i.e., ~ 81% reduction; exp (β) = 0.19; 95% CI: 0.13, 0.28; P < 0.001) and 0.02 (i.e., ~ 98% reduction; exp (β) = 0.02; 95% CI: 0.01, 0.07; P < 0.001) times, respectively, those issued immediately after the installation of the appliances. Regardless of treatment type; overall OHRQOL improved from the first to the twelfth month of AOB treatment. The functional limitations score decreased in the S group. Children showed easy adaptation, and their discomfort decreased 1 week after the installation of the appliances.Trial registration: Clinicaltrials.gov; NCT03702881, date of registration: October 11, 2018., (© 2024. The Author(s).)

Introduction: Mesiodistal angulation of premolars and molars can be altered by forces of open bite malocclusion. The aim of this study was to compare the mesiodistal angulations of the posterior teeth in class I, II, and III individuals with anterior open bite (AOB) versus individuals with harmonious occlusion., Methods: This comparative cross-sectional study used 299 lateral head radiographs of individuals with permanent dentition. There were 4 groups (harmonious occlusion [n=89], Class I open bite [OB] [n=75], Class II OB [n=66], and Class III OB [n=69]). Premolar (1UPM, 2UPM) and molar (1UM, 2UM) angulations were measured relative to the occlusal plane and the palatal or mandibular plane by a trained and calibrated evaluator. ANOVA and Scheffe tests were used for statistical analyses (P<0.05)., Results: The mesial angulation of the upper premolars showed greater angulation of between approximately 2° and 5° in the OB groups compared to the harmonious occlusion group (P<0.05). Only in the Class II OB group did the first and second upper molars show distal angulation in relation to the palatal plane (1UM 81.85°±5.42°; 2UM 75.32±7.4°) (P<0.05). The Class III OB group presented the greatest distal angulations of the lower premolars and molars (between 3° to 5° of difference, P<0.05) in relation to those of the harmonious occlusion group., Conclusions: The upper first premolars in all the AOB groups and the lower second premolars in the Class II OB group had greater mesioangulation. Additionally, the upper molars of the Class II OB group and the lower molars of the Class III OB group showed distoangulation compared with the molars in the group with harmonious occlusion., (Copyright © 2023 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Background: This study aims to evaluate the diagnosis of proximal carious lesions through different parameters of execution and visualization of the images., Material and Methods: Proximal carious lesions were artificially induced in human teeth three different times (10, 20, and 30 hours) by in vitro demineralization. The teeth were radiographed with the Dürr digital system using three exposure times (0.10, 0.16, and 0.20s) and three different resolutions in the scanning of the phosphor plates (20-, 25- and 40-line pairs). After acquiring the images, they were submitted to VistaScan Fine, Caries 1, and Caries 2 software filters. Three radiologists analyzed the images in JPEG format., Results: The Pearson's chi-square test showed an association between longer demineralization time and the presence of injury according to the professional's classification. There was no statistically significant association among the other parameters, exposure time, resolution, and use of filters and the presence of a lesion. All parameters showed a greater sensitivity than specificity. The exposure time of 0.2s showed better accuracy, the resolutions 25 and 40lp showed equal results and better than 20lp and the Fine filter obtained better values than the Caries 1 and 2 filters., Conclusions: Despite the variation of parameters, exposure time, resolution, and use of filters, there were no statistically significant differences. For better diagnostic accuracy, it is recommended to use 0.2s of exposure time and a Fine filter, and scan the phosphor plates with 25lp. Key words: Orbital fracture, Etiology, Orbital trauma, Road traffic accidents, Trauma., Competing Interests: Conflicts of interest None declared., (Copyright: © 2024 Medicina Oral S.L.)

Aim: The aim of this study was to determine the sagittal position of the upper incisor considering Andrews' analysis based on the position of the forehead in Peruvian individuals with different skeletal relationships., Materials and Methods: This retrospective, cross-sectional study included 212 lateral head radiographs of Peruvian individuals (males: 85, mean age 21.38 ± 6.88, and females: 127, mean age 21.18 ± 6.95), with different skeletal relationships (Class I group = 96, Class II group = 57, Class III group = 59). The values of the ANB, SNA, SNB angles as well as the forehead anterior limit line (FALL) and goal anterior limit line (GALL) points were identified in the radiographs, and then a vertical line was drawn in each point to determine if the upper incisor was positioned forward (protruded), backward (retruded) or within (adequate) these lines. Two trained and calibrated investigators performed all the measurements. The Chi-square test was used to evaluate associations. A p -value < 0.05 was considered statistically significant., Results: Overall, the sagittal position of the upper incisor showed a significant association with the sagittal skeletal relationship ( p = 0.001). The upper incisors showed an adequate position (41.7%), protruded position (56.10%), and retruded position (42.40%), for Class I, II, and III skeletal relationships, respectively, as highest percentages in each Class. Statistical significance was found for females only ( p = 0.005)., Conclusion: Skeletal Class I mainly showed an adequate position of the upper central incisor, whereas for Class II a protruded position was most frequently found, and Class III presented a retruded position., Clinical Significance: Andrews' analysis based on the position of the forehead in Peruvian individuals is a valuable tool for orthodontic diagnosis. How to cite this article: Bazán-Mendoza JR, Arias-Modesto PB, Ruíz-Mora GA, et al . Sagittal Position of the Upper Incisor in Relation to the Forehead in Peruvian Individuals with Different Skeletal Relationships. J Contemp Dent Pract 2023;24(11):821-825.

Introduction: This study aimed to develop a 3-dimensional (3D) characterization of the severity of maxillary impacted canines and to test the clinical performance of this characterization as a treatment decision support tool., Methods: Cone-beam computed tomography images obtained from 83 patients with 120 impacted maxillary canines were included. Quantitative information on the canine 3D position and qualitative assessment of root damage of adjacent teeth were evaluated. A severity index was constructed on the basis of the quantitative findings. Clinical applicability was tested by comparing clinical diagnosis and treatment planning for conventional records vs the 3D characterization via a 2-part survey., Results: The average quantitative assessments of impacted maxillary canine position were 6.4 ± 3.6 mm from the midsagittal plane, 11.6 ± 3.1 mm in height relative to the occlusal plane, 31.5° ± 18° of roll, and 48.8° ± 14.3° of pitch. The severity index ranged from 0-13 with a mean score of 4.5 ± 2.2. Overlap with adjacent teeth was the greatest contributor (33%) to the index. Bicortically impacted canines caused the most severe root damage. Cone-beam computed tomography was preferred for assessing root damage and overall severity, whereas conventional imaging was sufficient for height and angulation assessment. The 3D report was very important or important for evaluating root damage, canine position, overall severity, and overlap. The 3D report changed most of the decisions relating to biomechanics, patient education, and treatment time estimate. The decision of exposure and traction vs extraction was changed 22% of the time after the presentation of the 3D report., Conclusions: The overlap with adjacent teeth frequently contributes the most to the severity index. The 3D report provided relevant clinical information regarding the canine position, damage to adjacent teeth, and the severity index, with a profound impact on the decisions of the clinicians regarding biomechanics, patient education, and treatment time estimate., (Copyright © 2023 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

The objectives of the treatment of impacted canines differ according to the characteristics of dental malocclusion. Traction of the tooth is a conservative and viable alternative, which allows for maintaining stability and occlusal function. The following case report describes the treatment of an 11.6-year-old female patient, who presented bilateral impaction of mandibular canines in contact with the midline, mixed dentition in the inter-transitional period, class I angle malocclusion, with light crowding teeth. The treatment comprised three phases. The first phase, verticalization of the mandibular canines in mixed dentition, was performed to pull the impacted bilateral mandibular canines towards the dental arch to achieve their verticalization, maintaining the molar relationship, and the position of the upper and lower incisors. In the second phase, osteogenic rest was planned to relieve post-traction stress while awaiting the replacement of the mixed dentition. Finally, the third phase in permanent dentition was to align and level canines within the arch after extraction of the deciduous canines. For the viability of the permanent mandibular canines in the dental arch, orthosurgical traction was implemented, with a traction system with closed nickel-titanium coil springs with a transitory rigid dental-mucous-supported anchorage device, which allowed control and protection of the adjacent teeth and movements with helical forces of a controlled three-dimensional range. The results of the treatment were adequate, achieving consolidated molar and canine relationships, overjet, overbite, and optimal facial balance., Competing Interests: The author(s) declare(s) that they have no conflicts of interest., (Copyright © 2023 Gustavo Armando Ruíz-Mora et al.)

Background: Analysis of the facial biotype can provide useful information for orthodontic diagnosis and can determine the type of growth of a patient to guide orthodontic treatment. The objective of this study was to determine the concordance of the facial biotype according to Bjork-Jarabak cephalometric analysis and photographic analysis of the angle of facial opening in Peruvian individuals., Material and Methods: This retrospective study included 244 cephalometric radiographs and frontal photographs of the same patients obtained from a database. The facial biotype (mesofacial, brachyfacial, or dolichofacial) was determined with the Björk-Jarabak polygon (cephalometric) and the angle of facial opening (photographic). Two trained investigators performed all the measurements. The concordance of the facial diagnosis was determined using correlations of the interclass coefficient and the kappa test. p <0.05., Results: In cases with a mesofacial biotype, both analyses coincided in 60 individuals (68.2%), while in those diagnosed with a dolichofacial biotype, the analyses only coincided in 17 individuals (10.4%). There was no concordance between the two methods regarding the brachyfacial biotype since according to the angle of facial opening none of the individuals presented a brachyfacial biotype (kappa weighted test= 0.020, p =0.586)., Conclusions: Cephalometric and photographic analyses should be complementary and one should not substitute the other. Attention should be focused on dolichofacial and brachyfacial biotypes, which showed less concordance between evaluations. So, more studies are needed to follow this line of research. Key words: Facial biotype, cephalometry, photography, facial type, radiography., Competing Interests: Conflicts of interest None declared., (Copyright: © 2023 Medicina Oral S.L.)

Objective: To quantify the volume of the follicular spaces of impacted lower third molars (ILTMs) with different impaction positions and angulations using cone-beam computed tomography (CBCT) and to determine its association with the histopathological findings., Study Design: This study included 103 ILTMs of 33 men and 70 women aged 18-46 years (mean age, 29.18 years). The follicular space volumes were measured on CBCT by manual segmentation and correlated with the histopathological diagnosis of each ILTM having different impaction positions and angulations. Statistical Product and Service Solutions, version 24, was used for statistical analyses by applying the t -test and binary logistic regression and multiple linear regression tests (p < 0.05)., Results: Overall, 83 (80.6%) dental follicles presented a non-pathological diagnosis (mean follicular volume, 0.10 cm 3 ), whereas 20 (19.4%) presented a pathological diagnosis (mean follicular volume, 0.32 cm 3 ; p = 0.001). Similarly, the impaction depth in Position C cases was associated with a pathological diagnosis (p = 0.010)., Conclusion: The follicular volume of the ILTMs varied significantly in teeth with a histopathological diagnosis of a follicular cyst and was associated with the impaction depth, mainly in Position C cases, and its relationship with the mandibular ramus. A mean follicular volume of 0.32 cm 3 was associated with a greater probability of a pathological diagnosis., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors.)

Background: Breastfeeding has multiple nutritional, immunological and psychological benefits, as well as a positive influence on the development of the stomatognathic system., Objectives: The present study attempted to determine the relationship between the duration of breastfeeding and the development of non-nutritive habits, and transversal and vertical occlusal alterations in preschool children., Material and Methods: This cross-sectional study involved 155 preschoolers aged 2-5 years from 3 public schools in Lima, Peru. The sample was divided into 2 groups with regard to the duration of breastfeeding: group A (n = 50) included infants that had been breastfed for up to 6 months; and group B (n = 105) included infants that had been breastfed for 6-12 months. Two trained and calibrated dentists evaluated each group, and clinically determined the presence or absence of transversal or vertical occlusal alterations. Likewise, the children's parents or caregivers were consulted to determine the development of non-nutritive habits., Results: A significant association was found between breastfeeding duration and the development of the oral breathing habit; groups A and B showed a prevalence of 30.0% and 16.2%, respectively (p = 0.048). Likewise, breastfeeding duration affected the appearance of oral breathing (OR (odds ratio) = 0.84; 95% CI (confidence interval): 0.74-0.96; p = 0.011). Furthermore, the use of a bottle for more than 24 months significantly influenced the appearance of oral habits (OR = 3.55; 95% CI: 1.20-10.55; p = 0.022) and open bite (OR = 12.12; 95% CI: 1.16-126.31; p = 0.037)., Conclusions: Breastfeeding duration of 6-12 months was shown to be a protective factor in preventing the appearance of oral breathing. Posterior crossbite (PCB), open bite and deep bite seemed not to be influenced by breastfeeding duration. However, the use of a bottle for more than 24 months significantly influenced the appearance of anterior open bite.

Introduction: To compare the root morphology of the maxillary lateral incisors (MLIs) adjacent to an impacted (IMC) versus non-impacted maxillary canine (non-IMC)., Materials and Methods: This cross-sectional study included cone beam computed tomography (CBCT) images derived from 154 subjects (with unilateral/bilateral impacted maxillary canines or without canine impaction). Each MLI was considered as a unit of analysis. Thus, the study group included 122 MLIs adjacent to impacted maxillary canine (IMCG) and the control group included 122 MLIs adjacent to a non-impacted maxillary canine (CG). Groups were matched by age, sex and evaluation side. Root length, root dilaceration angle and root convergence angle were evaluated in both the coronal and sagittal planes. Comparisons between groups were made with Student's t-test and the chi-square test with Bonferroni correction (P<0.008, P<0.01, respectively)., Results: The root measurements of the MLIs showed some significant differences between the groups. The coronal root length was 0.52mm shorter but not highly significant (P=0.032), the coronal root dilaceration angle was 7.51° smaller (P<0.001), and the coronal root convergence angle was 1.28° greater (P<0.001) in the IMCG compared to the CG. The orientation of root dilaceration in the MLIs showed significant differences between the groups: it was mostly distopalatal in the GC (87.5%), to a lesser extent in the IMCG (58.9%) and also mesiopalatal in the IMCG (22.3%), (P=0.001)., Conclusions: The root morphology of MLIs adjacent to an IMC showed a tendency of shorter length, smaller root dilaceration and greater root convergence in the coronal section than MLIs adjacent to a non-IMC., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Introduction: This ex vivo study aimed to compare the adaptation of single gutta-percha cone in teeth prepared with the Wave One Gold and Reciproc Blue reciprocating systems through cone-beam computed tomography., Materials and Methods: A total of 40 recently extracted mono radicular premolars were randomly assigned into two groups ( n =20) corresponding to Reciproc Blue and Wave One Gold reciprocating systems and adapted to a single cone system. Each group was evaluated by cone-beam computed tomography at 1 mm, 2 mm and 4 mm from the apical foramen. We evaluated the number of walls adapted by the cone, quality of filling and the number of spaces between the filling and the walls of the root canal. The Mann-Whitney U and T-tests were employed to associate and compare both groups ( P <0.05)., Results: At 1 mm in the lingual wall the Wave One Gold system did not adapt by 45% compared to 15% with Reciproc Blue ( P <0.05). Likewise, the single-cone filling technique of the Reciproc Blue system showed better sealing quality obtaining an ideal category (75%) compared to Wave One Gold (40%) ( P <0.05). The amount of space (mm) found between the cone and the filling walls was greater with Wave One Gold. However, these values were not statistically significant., Conclusions: Based on this ex vivo study the better adaptation of root canals and ideal filling condition was more frequent with Reciproc Blue than Wave One Gold system, mainly at 1 mm from the radicular apex., Competing Interests: ‘None declared’.

Primary failure of eruption (PFE) is an autosomal disease that occurs in approximately 0.06% of the population and is defined as the malfunction of dental eruptive mechanisms with delay and absence of these processes in a non-ankylosed tooth. Treatment options for patients with eruptive delays range from prosthetic to surgical interventions. Although this condition is relatively rare, the occurrence of eruptive disorders in clinical dental practice is becoming more frequent. Correct diagnosis of this eruptive anomaly plays an essential role in treatment planning. The aim of this case report was to describe the treatment of a case of multiple PFE with a biomechanical approach to extrusive traction using NiTi closed coil springs and a customized rigid anchorage. In conclusion, complex orthodontic cases with eruptive delay and variants of PFE can be successfully intervened to make morphologically and functionally compromised dental organs viable, if diagnosed and treated in a timely and preventive manner by a multidisciplinary approach using alternative biomechanics for efficient osteogenic traction., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: To three-dimensionally evaluate the characteristics of mandibular canine impaction with the morphometry of the roots of the lower incisors., Material and Methods: Cone-beam computed tomography (CBCT) scans of 35 individuals (18 males and 17 females) with a mean age of 14.37± 10.26 years were evaluated. Forty-three impacted mandibular canines (IMbC) were evaluated. Their location, sector and level of impaction were determined. Likewise, the distances of the canines to the occlusal plane, the angulations with respect to the midline and adjacent lateral incisors, the length of the impacted canines, and of the lower incisors were measured. Finally, the presence of incisor root resorption was determined. Chi-square and Kruskal Wallis tests were employed ( P <0.05)., Results: The buccal position of the IMbCs was the most predominant (65.1%), and the location below the apical middle third of the lower incisor root was the most frequent (32.6%). No statistical significance was found between root resorption and location, level and impaction sector. Only mild root resorption and impaction sector 5 was significant (66.70%; P <0.001). The proximity of the follicle and crown of the IMbC did not affect the root structure of the lower incisors. 72.1% and 52.2% of mandibular canines did not present contact of the impacted canine or its follicle with the adjacent tooth respectively. Root lengths were similar in the different types of impactions ( P >0.05)., Conclusions: IMbCs are mostly positioned buccally and below the apical middle third of the root of the lower incisors. Likewise, the proximity of their follicles and crowns does not seem to affect the root structure of the lower incisors, producing minimal and infrequent root resorption. Key words: Mandibular canine impaction, incisor root morphometry, cone-beam CT., Competing Interests: Conflicts of interest None declared., (Copyright: © 2022 Medicina Oral S.L.)

Bullying is a social problem that affects children and adolescents in particular. It deteriorates the selfesteem of its victims, decreases their quality of life and generates future psychological problems. The aim of this review was to determine the influence of dentofacial characteristics on the appearance of selfreported bullying through a literature review. A systematic search was carried out in the databases of international scientific literature on health sciences, including MEDLINE via PubMed, Scopus, LILACS, and SciELO. Up to October 10, 2020, a total of 348 articles were identified, but only 36 were ultimately selected for the review. Specific keywords in English were used in the search: "dentofacial features"; "soft tissue"; and "malocclusion". It was found that the appearance of bullying was associated with altered facial profiles, namely the presence of different classes of malocclusion, with class II or class III malocclusion being the most impactful. Altered dentofacial characteristics can make an individual the target of harassment, leading to low quality of life, emotional instability, low self-esteem, and the lack of confidence with regard to dentofacial appearance as well as poor long-term social and academic performance. There is a need to develop preventive measures that would be applied by both parents and authorities, with disseminating information on bullying in schools as well as on adequate oral hygiene and the importance of going to the dentist. Traditional and cybernetic bullying share similarities. While working out strategies against bullying, it is essential to raise awareness among victims and bullies, families, and society, and to determine how bullying is perceived by children and teenagers.

Forensic dental autopsy is a fundamental procedure for the study of a death under judicial investigation in the search for postmortem (PM) information that can be compared with the antemortem (AM) data available from the cadaver. One of the major difficulties in taking postmortem evidence is the opening of the mouth, limited in many cases by the phenomenon of cadaveric rigidity or rigor mortis. The aim of this study was to evaluate the effectiveness of a new device designed to facilitate the opening of the dental arches in rigor mortis corpses. For this purpose, a sample of 30 corpses (22 men and 8 women; mean age 42.18 years and 38.75 years) from the Institute of Legal Medicine of the city of Lima (Peru) was analyzed. A forensic odontologist designed and manufactured the apparatus and carried out the sample analysis process. The initial and maximum measurements of oral cavity opening were recorded and a paired Student's t-test was applied to observe the difference between these initial and maximum measurements obtained (p < 0.05). The results showed that the average oral opening obtained with the new appliance was 43.83 ± 3.62 mm, with an average initial opening of 6.49 ± 3.04 mm (p < 0.001). The efficacy was similar in men and women (maximum opening M: 51.70 mm - F: 53.00 mm). In 29 of the 30 carcasses studied (96.7%) an opening greater than 40 mm was obtained, the latter being a minimum measurement sufficient to access the oral cavity. The efficacy of this new instrument for oral autopsy purposes is highlighted, since it does not cause destruction of the soft tissues and allows the correct manipulation of the oral structures present., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

This randomized clinical trial aimed to compare the three-dimensional dentoalveolar maxillary changes after anterior open bite treatment with bonded spurs and build-ups versus bonded spurs alone. Patients from 7 to 11 years of age with anterior open bite were randomly allocated into two groups. Bonded spurs and posterior build-ups were used in the experimental group and only bonded spurs were used in the comparison group. The randomization sequence was generated at www.randomization.com . Opaque, sealed and sequentially numbered envelopes were part of the allocation concealment. Digital dental models were acquired before (T1) and after 12 months of treatment (T2) and de-identified for analysis purposes. Three-dimensional changes of maxillary permanent incisors and first molars were evaluated by means of T1 and T2 dental model superimposition. Landmark-based registration on the posterior teeth and registration on the palate using regions of interest were performed. T or Mann-Whitney U tests were used for intergroup comparisons (P < 0.05). Mean difference (MD) and 95% confidence interval (CI) were calculated. Twenty-four children (17 girls and 7 boys) were included in the experimental group (mean age 8.22 ± 1.06 years) and 25 children (14 girls and 11 boys) were included in the comparison group (mean age 8.30 ± 0.99 years). After 12 months of treatment, inferior displacements of maxillary incisors were similar in the experimental (1.55-2.92 mm) and comparison (1.40-2.65 mm) groups. Inferior displacement of the maxillary molars was also similar in both groups (MD: - 0.13 mm; 95% CI - 0.38, 0.12). The experimental and comparison groups showed medial and lateral displacements of the permanent first molars, respectively (MD, - 0.31 mm; 95% CI - 0.51, - 0.11). Lingual inclination of the permanent first molars were observed in the experimental group and buccal inclination in the comparison group (MD, - 2.16°; 95% CI - 3.72, - 0.60). Similar three-dimensional displacements of maxillary central and lateral incisors, and inferior displacements of maxillary permanent first molars were observed in both groups. Bonded spurs associated with posterior build-ups demonstrated some medial displacement and lingual inclination of the maxillary permanent first molars while opposite changes were noticed in the comparison group.Trial registration: Clinicaltrials.gov; NCT03702881, date of registration: October 11, 2018., (© 2022. The Author(s).)

Background: Using different software to evaluate the airways, with different thresholds, but within the range for airway recognition, could yield different measurements in the same patient with or without craniofacial disharmony., Objectives: The aim of the present study was to compare the volume and the most constricted area (MCA) of the oropharynx in individuals with or without an open bite by using 2 software programs meant for cone-beam computed tomography (CBCT)., Material and Methods: This comparative study included 60 cases selected from 137 CBCT scans obtained from individuals with the presence or absence of an open bite. Each group included adults of both genders - in total 30 women and 30 men - with a mean age of 27.57 ±11.85 years in the open bite group and 26.23 ±6.78 years in the control group. The oropharyngeal volume and MCA were measured with 2 three-dimensional (3D) software packages: Planmeca Romexis®; and Nemotec NemoStudio®. Two calibrated orthodontists trained in the use of the software made the measurements. Data was analyzed using Student's t tests for independent and paired samples (p < 0.05)., Results: In general, the oropharynx volume measurements obtained with the NemoStudio software were significantly higher than those obtained with Romexis (19,007.17 ±8005.79 mm3 and 17,823.47 ±7148.62 mm3, respectively) (p = 0.020). However, when the groups were analyzed separately, the measurements of the group with an open bite did not differ according to the software used (p = 0.352). The measurements of the MCA of the oropharynx were significantly higher when obtained with the NemoStudio software (MD (mean difference) = 19.02 mm2) (p = 0.005). In contrast, no difference in the MCA results for the 2 software packages was found in the open bite group (p = 0.728)., Conclusions: The volumetric and cross-sectional measurements of the oropharyngeal airway, particularly in individuals without an open bite, were affected by the software used.

Background: The main objective of this study was to describe the dentoalveolar and occlusal characteristics of subjects with primary failure of eruption (PFE) in cone beam computed tomography (CBCT) and compare them with a control group without the anomaly., Material and Methods: This retrospective and comparative study evaluated CBCT images of 80 permanent molars divided into 2 groups of 40 molars each, which had or did not have PFE characteristics. Using CBCT a calibrated orthodontist performed 23 measurements related to the distances of the cusps to the occlusal, palatal and mandibular planes and measured the buccal-palatal and mesiodistal widths of the molar crowns and their root lengths. Independent Student's t or Mann-Whitney U tests were used to compare occlusal and dentoalevolar characteristics between groups according to the normality of the data. P <0.05., Results: Molars affected by PFE were smaller in coronal dimensions in the PFE compared to the non-PFE group (Buccal-palatal crown width 11.60±0.95mm vs. 12.21±1.09 mm; p <0.001; and mesiodistal crown width 10.81± 1.07 mm vs. 11.84±1.32mm, respectively; p <0.001). The distal and mesial root lengths were approximately 2 mm smaller in the PFE group ( p <0 .001). The three-dimensional bony position was more convergent with respect to the palatal plane, i.e., the crown was more inclined palatally and distally in the PFE compared to the non-PFE group., Conclusions: Patients with molars affected by PFE present smaller bucco-palatal, mesio-distal coronal widths and mesial and distal root lengths than those without PFE and in these teeth the crowns are more inclined palatally and distally in upper molars. These specific characteristics may be pathognomonic of PFE and should be considered by clinicians when evaluating or treating patients with this condition. Key words: Occlusal characteristics, primary failure of eruption, cone-beam CT., Competing Interests: Conflicts of interest The authors declare they have no potential conflicts of interest with respect to the research, authorship and / or publication of this article., (Copyright: © 2022 Medicina Oral S.L.)

Aim: To develop, apply, and evaluate a virtual learning object (VLO) for teaching undergraduate dental students and paediatric dentists to diagnose and manage molar incisor hypomineralization (MIH)., Design: This controlled educational intervention included 170 undergraduate dental students and 50 paediatric dentists. The student intervention group (VLOG) was trained by the VLO, the control group of students (CG) received a synchronous virtual class, and the group of paediatric dentists (PDG) was trained by the VLO. Pre-test and post-test data were analyzed with a mixed one-way and Tukey's post hoc ANOVA test (α = 0.05). The answers to the questionnaire were analyzed with the one-way ANOVA test and Tukey's post hoc test (α = 0.05)., Results: The values obtained in the pre-test were significantly lower than those obtained in the post-test for all groups. The specialists showed a higher level of knowledge before and after the MIH training compared with the students (p < .001). Similarly, statistical differences were found in the level of knowledge, which increased after MIH training (p < .001). There were no differences between the CG and VLOG., Conclusions: The level of knowledge increased in all groups after training regardless of the method used. VLOG works similar to traditional teaching approaches., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

Objective: To calculate the association between the type and duration of breastfeeding and the deciduous molar relationship and facial characteristics of preschoolers aged 2 to 6 years., Study Design: This crosssectional study included 160 pre-schoolers aged 2 to 6 years old, enrolled in the 2019 academic year from 3 public schools in Data collection involved two phases. The first phase consisted in determining the facial type, anteroposterior and vertical profile, facial dimensions, and the molar relationship between primary second molars. The second phase included interviews with the parents or legal guardians. Children with exclusive breastfeeding and with mixed/artificial feeding (breastfeeding and bottle-feeding, or exclusive artificial bottle-feeding) were included. Chi-square test, t-test, multiple linear regression, and binary logistic regression tests were applied (p<0.05)., Results: The facial length, width, and the lower third were greater in the exclusive breastfeeding group than in the mixed/artificial feeding group (3.74mm, p=0.002; 2.06mm, p=0.047; and 2.94mm, p=0.015; respectively). In addition, children with breastfeeding for more than six months showed greater facial length, facial width and lower third (3.20mm, p=0.038; 3.68mm, p=0.006; and 3.57mm, p=0.026; respectively). The duration of exclusive breastfeeding influenced facial width, noting an increase of 3.32mm (p=0.011) if a pre-schooler had exclusive breastfeeding for more than six months., Conclusion: There were no significant associations between type and duration of breastfeeding and the molar terminal plane, facial type, or profile. However, facial dimensions were greater in the exclusive breastfeeding group, and when breastfeeding was longer than six months.

Purpose: Computer-guided surgery has been increased in recent years. Nonetheless, few data are available on the validation of this technique for immediate implant placement. The purpose of this in vitro study was to evaluate the accuracy of computer-guided surgery in immediate implant placement., Materials and Methods: Cone-beam computed tomography scans (CBCTs) and virtual models were obtained of eight fresh pigs hemi-mandibles to perform the digital planning of implants placement. Fifteen implants were simulated, and surgical guides were designed to transfer the digital planning to the surgical procedure. Postsurgical CBCTs were performed to compare the position of the planned implants versus the real implant position. Paired t -test and the intra-class correlation coefficient (ICC) were used to assess the mean differences and correlations in each outcome variable evaluated twice by one experienced researcher. Furthermore, variations were compared with the results reported in the scientific literature using a one-sample t -test P < 0.05., Results: The measurements of the outcome variables (implants position at the neck and apex level and the angular deviation) showed significant reproducibility (mean difference-0.01 mm, 0.07 mm, and 0.30°, respectively, P > 0.05). The ICC values ranged from 0.888 to 0.949. Furthermore, the mean deviation was 1.43 mm at the implant neck, 2.19 mm at the apex, and 6.81° for the angular deviation. Similarly, significant differences ( P < 0.05) were found at the neck and angular deviation when comparing the results with values reported in the literature., Conclusions: Although some variations were observed, they did not have a clinically significant impact. Therefore, computer-guided surgery could be satisfactorily used in immediate implants placement., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Society of Periodontology.)

Objective: To compare and assess the reproducibility of 3 methods for registration of maxillary digital dental models in patients with anterior open bite. Settings and sample population Digital dental models of 16 children with an anterior open bite in the mixed dentition were obtained before (T1) and after 12 months of treatment with bonded spurs (T2)., Methods: Landmarks were placed on all T2 models and 3 registration methods (R1, R2 and R3) were independently performed by 2 observers. R1 was based on 10 landmarks placed on posterior teeth. R2 was based on 5 landmarks on the palate (2 anterior, 2 posterior and 1 central). R3 used regions of interest around the 5 palatal landmarks used in R2. The differences between the registration methods were calculated by comparing the mean differences and standard deviations between the corresponding x, y and z coordinates of 6 corresponding landmarks in the T2 registered models. Repeated measures analysis of variance followed by post-hoc Bonferroni tests were used for comparisons (P < .05). The agreement between methods and the intra and interobserver reproducibility were assessed with Bland-Altman tests and intraclass correlation coefficients (ICC)., Results: Comparisons of R2 with R3 methods showed greater agreement, mean differences ≤0.50 mm for all landmarks, than comparisons of R1 with R2, and R1 with R3, mean differences >0.50 mm for most of the y and z coordinates (P < .05). The R1 and R3 methods presented excellent intra and interobserver reproducibility and R2 method had moderate interobserver reproducibility., Conclusions: Longitudinal assessments of open bite treatment using digital dental models could consider the posterior teeth and/or the palate as references. The R1 and R3 methods showed adequate reproducibility and yield different quantitative results. The choice will depend on the posterior teeth changes and dental models' characteristics., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Botulinum toxin is used as an alternative for the treatment of chronic refractory myofascial pain derived from temporomandibular disorders (TMDs). It is important to establish the benefits of botulinum toxin in this type of symptomatology. The aim of the study was to conduct a systematic review in order to evaluate the effects of botulinum toxin in patients with myofascial pain related to temporomandibular disorders. The search was carried out systematically, without limitations of language or year of publication, until February 2021. The databases searched included PubMed, Web of Science, Scopus, The Cochrane Library, and Latin American and Carribean Health Sciences Literature (LILACS). Partial gray literature was searched using Google Scholar, ClinicalTrials.gov, OpenGrey, and the reference lists of selected articles. Randomized controlled clinical trials evaluating the effects of botulinum toxin in the treatment of myofascial pain were included. The risk of bias was assessed with the Cochrane RoB 2.0 tool, and the The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to determine the certainty of the scientific evidence. A total of 900 studies were retrieved, out of which only 8 randomized clinical trials were selected. From these 8 studies, the data of a total of 314 patients, predominantly women, between the ages of 18 to 75 years was obtained. After the assessment of the studies with the RoB 2.0 tool, 7 studies showed some concerns regarding the reported results and only one was at a low risk of overall bias. The analysis of the studies has shown that low doses of botulinum toxin are effective in the treatment of refractory myofascial pain associated with temporomandibular disorders. The studies presented mediumto low-certainty evidence..

Dentistry schools have attempted to overcome the challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic through teaching via the Internet with the use of virtual platforms, designed to simulate face-to-face interaction and counteract the social isolation affecting the integral development of students. This review searched the main health databases, including MEDLINE via PubMed, Scopus and LILACS, and selected 31 articles to proceed with the research. During the pandemic, platforms such as Facebook, Instagram, YouTube, Zoom, Google Meet, and other similar tools allowed teachers to develop dynamic slides and dental models to simulate procedures, which played an important role in the course of mainly theoretical classes. In addition, applications such as WhatsApp allowed the rapid acquisition and sharing of useful information on a specific topic. While virtual resources facilitate the learning process through generating interest as well as providing accurate, necessary, valuable, and easily accessible information, which is constantly updated, the disadvantages of remote learning include the lack of instruments, infrastructure and materials, apart from supervision, to promote personal development and progressive evolution to directly treat patients. Another issue with regard to virtual learning is whether within a short period of time students can achieve a comparable level of practical skills as in the case of the conventional learning. In conclusion, the current pandemic has changed not only the use of technology in education, but also educational strategies for the future.

The purpose of this research was to determine biosecurity measures at the dental office after the appearance of coronavirus disease 2019 (COVID-19). A search was conducted in the main databases of the scientific literature using the words "COVID-19, coronavirus, SARS-Cov2, biosecurity, disinfection and dentistry." We analyzed biosecurity and disinfection standards at the dental office and dental health personnel to date, and their adaptation to the needs and way of working of each. As a result, according to the information collected the following procedure was identified: a telephone appointment must be made and a questionnaire should be given before dental care; at arrival to the appointment, the temperature of the patient should be taken and proper cleaning and disinfection of the waiting room should be maintained. Panoramic radiography and CBCT are the auxiliary methods of choice. Absolute isolation and atraumatic restorative therapy techniques are a good alternative to decrease fluid exposure. The removal of protective clothing and accessories must follow a specific order and washing hands before and after is essential. In conclusion, the efficient biosecurity for dentists and patients in all dental care processes before, during, and immediately after the appointment reduces the risk of COVID-19 infection and allows healthy dental care environments.

The aim of this investigation was to describe the craniofacial and oral characteristics of children and/or adolescents with and without Down syndrome (DS). A bibliographic search of the Medline database (via PubMed), Scopus and SCIELO was performed using the keywords "craniofacial characteristics", "dental characteristics" and "Down syndrome". Systematic reviews, observational cross-sectional and longitudinal studies were included. On the contrary, case reports, letters to the editor, editorials and opinion articles were excluded. 251 articles were recovered, and only 30 fulfilled the selection criteria. DS patients were characterized by reduced dimensions of the maxillary bone, mandible, and skull base, compared to normal patients. Likewise, some of these abnormalities influenced more frequent presentation of a class III malocclusion in these patients. On the other hand, this population group showed a higher prevalence of periodontal diseases, less risk of dental caries, and the presence of alterations in the tongue, lips, dental development and palate morphology. The quality of life of these individuals is affected by difficulties in swallowing, talking, eating or breathing through the nose. In conclusion, the craniofacial and oral characteristics of DS patients present various alterations compared to healthy patients, and these alterations have a negative impact on their quality of life., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the presence of calcifications in the internal carotid artery (ICA) in cone-beam computed tomography (CBCT), and to verify the association of these findings with sex, age, dental condition, and risk factors associated with vascular disorders., Methods: The CBCT scans used in this study were obtained from the database of a private dental clinic requested for the planning of rehabilitation with dental implants. The selection criteria were patients aged 40 years and above. Out of a pool of 1176 CBCT examinations, a total of 284 scans of adult patients were evaluated by two blinded observers. Data were collected from patients' medical records., Results: ICA calcifications were present in 63.0% of the examinations. Most calcifications were in the intracranial pathway (166). Despite being present in a smaller number 57 (C1), extracranial calcifications were more severe. Spearman's ρ coefficients (rS) indicated that the number of missing teeth was directly associated with the presence of calcifications (p = 0.042) and severity (p = 0.020). The age variable also had a direct relationship with the presence of calcifications (p ≤ 0.0001), increasing its frequency and severity over the years. In addition, hypertension (p = 0.036) and use of antihypertensive drugs (p = 0.015) were directly associated., Conclusions: There is a high occurrence of ICA calcifications in CBCT as incidental findings in adult patients, and it is directly associated with age, number of missing teeth and hypertension., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: The purpose of this study was to describe sample size calculations in randomized clinical trials (RCTs) published in four orthodontic journals., Methods: This cross-sectional study evaluated 142 RCTs published from 2015 to 2019 in the four journals with the highest impact factor in orthodontics according to SCIMAGO 2018 ranking. Two trained and experienced orthodontists assessed if the RCTs evaluated reported their sample size calculations, and if they adequately described the criteria for the calculations, including the level of significance, test power, precision or effect size (clinically relevant difference), and expected variability. The reporting of sample size calculation was considered adequate when the above four criteria were described., Results: We identified 120 publications (84.5%) reporting the sample size calculation, but only 70 (58.3%) fully described the above parameters. Inadequate calculation included failure to report the confidence level (ranging from 0% to 12.9%), test power (ranging from 0% to 20%), effect size (ranging from 0% to 22.5%) and expected variability (ranging from 22.6% to 80%). According to the journal, some parameters of sample size calculation were more frequently reported., Conclusion: RCTs published in four leading orthodontic journals frequently do not report the parameters used for sample size calculations.

Background: The purpose of this study was to determine the clinical-epidemiological profile of patients with cleft lip and / or palate in Peru from 2006 to 2019., Material and Methods: This retrospective and cross-sectional study analyzed 3,923 patients with cleft lip and palate attended by surgical missions of the Operación Sonrisa Perú from January 2006 to December 2019. The clinical profile of the patients treated included: type of cleft (cleft lip CL, cleft palate CP, cleft lip and palate CLP and submucosal SM), surgery performed (cheiloplasty, palatoplasty, cleft rhinoplasty, fistula repair, pharyngeal flap), surgical time according to number of interventions. Likewise, affiliation variables such as sex, age and birthplace were recorded. Descriptive analysis was performed. Associations were determined using the Pearson's Chi-square test and Two-sample test of proportions were used for comparing the percentages during time. A p value <0.005 was considered significant., Results: The most frequent diagnosis was CP (n = 1411, 35.97%). We identified a statistically significant association between the diagnosis of CL, CP and gender ( p = 0.045), being more prevalent in males. A higher prevalence of CL was also observed on the left side and in males (n = 183). Cheiloplasty was the most frequent first surgical intervention performed (n = 837, 47.42%) followed by fistula repair as the second intervention (n = 428, 42.29%)., Conclusions: Cleft lip and palate are more frequent in males, with CP being the most frequent. CL is more frequent on the left side and the first surgical approach in these patients is lip closure. Key words: Epidemiology, cleft lip and palate, surgical missions., Competing Interests: Conflicts of interest The authors declare they have no potential conflicts of interest with respect to the research, authorship and / or publication of this article., (Copyright: © 2021 Medicina Oral S.L.)

Intraoral distalizers associated with skeletal anchorage provide the major benefit of promoting molar distalization with minimum anchorage loss and patient cooperation. This case report presents the treatment of a 17-year-old female with Class II Division 2 malocclusion, maxillary dentoalveolar protrusion, mild mandibular retrusion, increased overjet, deepbite, and lip incompetence. The treatment plan involved initial maxillary molar distalization with a customized version of the skeletally anchored dual force distalizer (DFD). The customized DFD used smaller mini-implants and included a fixed anterior biteplane. The device applied simultaneous forces from the buccal and palatal sides directly to the molars using nickel-titanium coil springs and allowed orthodontic mechanics in the mandibular teeth. An overcorrected Class I molar relationship was obtained after 6 months. After the distalization phase, retraction mechanics began with retraction loops and using a modified transpalatal bar reinforced with the mini-implants as anchorage. Moreover, the finishing phase was performed with multiloop edgewise archwires and intermaxillary elastics to enable an individualized control of each tooth. Total treatment time comprised 2 years 4 months, and significant improvements regarding the facial and occlusal perspectives were noticed. Similarly, these favorable changes remained stable during the 2-year follow-up period. The customized version of the skeletally anchored DFD followed by fixed appliances showed effectiveness and stability in Class II malocclusion treatment., (Copyright © 2021 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Treacher Collins Syndrome (TCS) is a genetic disorder with predominantly autosomal dominant inheritance, associated with different mutations in specific genes. This review aimed to evaluate the facial, temporomandibular, zygomatic and bucco-dental phenotype in TCS individuals, and describe surgical and non-surgical solutions for each case in order to improve the quality of life of these individuals. A review of the literature on the craniofacial characteristics of the TCS was carried out, using the PICO strategy, and then a systematic search method was performed in Medline, Scopus, LILACS and SCIELO databases, identifying articles of impact and relevance until 10 June 2020, 240 articles were recovered and only 35 fulfilled the selection criteria. We found the main craniofacial and oral morphological characteristics of these individuals, and the possible functional alterations inducing repercussion in the stomatognathic apparatus. Among other characteristics, the most representative include hypoplasia in the zygomatic and mandibular complex, which can cause difficulty in breathing and feeding. In some cases, cleft palate and malocclusions such as anterior open bite may lead to Angle's Class II malocclusion, sometimes causing problems in the temporomandibular joint. In conclusion, individuals with TCS have specific craniofacial features including maxillary hypoplasia, altered orbital zones, mandibular retrognathia, and temporomandibular disorders. Oral deformities produce to a higher prevalence of caries and calculus formation because of poor hygiene due to the malformations present in these patients., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Aim: To evaluate the effects of exposure parameters (tube current and voltage) to detect clear and unclear mandibular canals (MCs) using a complementary metal-oxide semiconductor (CMOS) or photo-stimulable phosphor plate (PSP) sensors., Methods: A total of 24 dry half-mandibles were divided into two groups with clear (n = 16) and unclear (n = 8) MCs. The retro-alveolar parallel technique was performed in the six-molar region of the mandibles using direct and indirect digital intra-oral sensors. Six combinations of tube voltage (kV) (60 kV, 66 kV, and 70 kV) and tube current (mA) (2 mA, 5 mA, and 8 mA) were applied, and 144 images of each group were obtained with each CMOS and PSP sensor. Images were processed using Image J software. To evaluate diagnostic accuracy, two square images of the first-molar region were obtained from each image, one with the MC inside and the other without the MC (a total of 576 images were observed). Three radiologists diagnosed the presence or absence of MCs. The diagnostic accuracy of each exposure parameter was compared with the area under the curve (Az) in receiver-operating characteristic analysis., Results: The Az values for clear MCs were higher than those for unclear MCs (P < 0.001). There were no significant differences when the tube current was modified. For unclear MCs, the Az increased when higher tube voltages were used, showing a significant difference using the PSP sensor (p = 0.004). There was no significant difference for clear MCs., Conclusions: Lower exposure parameters should be used for clear MCs, while higher tube voltage values should be used for unclear MCs., Competing Interests: None

The purpose of this investigation was to identify, synthesize, and compare all the current information on the efficacy of dental masks, emphasizing their use, types, and filters to prevent the spread and infection of COVID-19 and other infectious diseases. A bibliographic search of the main scientific databases was carried out using the words "masks, COVID-19, and dentistry." Articles without language restriction up to May 31, 2020, were obtained. The types of masks, their half-life, method to use, sterilization, and proposed alternatives for dental masks were analyzed. Most of the articles refer to the use of N95 or FFP2 respirators presented as a strategy to extend the life of the masks and limited reuse. Regarding sterilization, most of the articles presented studies using ultraviolet germicidal irradiation as the sterilization method. Regarding respirator mask half-life, we recommend prolonged use, combined with a disposable surgical mask over the respirator mask. Finally, the use of N95 or FFP2 respirators are recommended as part of personal protective equipment for dental use.

Purpose: This study aimed to compare the microshear bond strength (µSBS) of dual-cure resin cement in CAD-CAM zirconia after different cleaning techniques., Materials and Methods: Fifty discs of zirconia-based ceramic from Ivoclar Vivadent were embedded in acrylic resin. The discs were divided into five groups according to the cleaning methods used: Group 1: drying with spraying + sandblasting with Al 2 O 3 ; Group 2: washed with water and dried with spraying + sandblasting with Al 2 O 3 ; Group 3: washed with distilled water and dried with spraying + sandblasting with Al 2 O 3 + zirconium oxide (Ivoclean); Group 4: washed with distilled water and dried with spraying + sandblasting with Al 2 O 3 + potassium hydroxide (Zirclean); and Group 5: washed with distilled water and dried with spraying + sandblasting with Al 2 O 3 + 1% NaClO. All of the groups were contaminated with artificial saliva for 1 minute and then cleaned. Statistical analyses were performed using ANOVA and Tukey's tests., Results: There were statistically significant differences among all groups for µSBS ( P < .05). The group treated with zirconium oxide (Group 3) showed the highest µSBS (18.75 ± 0.23 MPa)., Conclusion: When applied to zirconia, the cleaning methods affected the bonding with resin cement differently., (© 2021 The Korean Academy of Prosthodontics.)

Work is a fundamental axis for the development of societies and human well-being, but if a person cannot adapt to their work area and work environment, the individual may be affected by occupational or coexisting illnesses that get exacerbated when working.A scientific search was conducted in the main health databases - MEDLINE (via PubMed), Web of Science, SciELO, Scopus, Google Scholar, and Dialnet - using the keywords "occupational health", "occupational diseases", "occupational accidents" AND "oral radiology" OR "oral radiologists". Systematic reviews as well as observational, cross-sectional and longitudinal studies were included. Case reports, letters to the editor, editorials, and opinion articles were excluded. In total, 496 articles were recovered, and only 51 fulfilled the selection criteria. Signs and symptoms that affect oral radiologists include back pain, shoulder pain, wrist pain, tenosynovitis, computer vision syndrome (CVS), stress, depression, and burnout syndrome. Preventive occupational health (OH) measures are proposed to help eliminate or alleviate the symptoms associated with non-ergonomic habits at work. Oral radiologists are exposed to several risks and occupational diseases inherent and/or related to their work. By implementing simple habits and ergonomic advice, well-documented in the literature, these risks can be avoided.This review aimed to provide scientific information on the current concepts of OH in oral radiologists in order to help prevent occupational diseases and occupational accidents, and guarantee safe professional practice.

Background: Digital models are considered the new standard in the clinical practice of orthodontics. However, they are difficult to use in the absence of a true scale for chairside use during clinical appointments. Therefore, an easy standardized method with true-scale paper print images would be of great utility. The aim of this study was to correlate and compare measurements obtained manually in true-scale paper printed images of digital models with those obtained digitally in the computer., Methods: Sixty desktop scanned digital models (30 upper and 30 lower) were analyzed. Ortho Insight 3D software was used for generating the printed images on paper and for measuring the digital models. Intercanine width, interpremolar width (first and second), intermolar width (first), and arch length measures were performed with both methods and were correlated and compared., Results: There was a high correlation between measurements performed with both methods. Values obtained from paper print images were lower and showed statistically significant differences (<0.4 mm; P < 0.001), which did not have any clinical implications., Conclusions: There is a high correlation between orthodontic measurements obtained manually in true-scale paper printed images of digital models and those obtained digitally in computer models, with no clinical differences between the two measurements. True-scale printed images of digital models can be used chairside in clinical appointments for the verification of measurements, or even as a guide for archwire individualization and shape bending without the need for long and complex processes or scale sizing adjustments., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: This single-center, 2-arm, parallel-group randomized clinical trial aimed to compare the dimensional dental arch changes after anterior open bite (AOB) treatment with bonded spurs associated with posterior build-ups vs bonded spurs alone., Methods: Patients aged between 7 and 11 years with AOB were recruited at a university clinic and randomly allocated into 2 groups. The experimental group was treated with bonded spurs associated with posterior build-ups (SBU) and the comparison group with bonded spurs alone (S). Digital dental models were obtained at pretreatment and after 12 months of treatment. The overbite change was the primary outcome. The randomization list was obtained at the Web site www.randomization.com. Allocation concealment involved sequentially numbered, sealed, and opaque envelopes. The outcomes' assessment was blinded. Analysis of covariance was used for intergroup comparisons (P <0.05). Mean difference (MD) and 95% confidence interval (CI) were obtained., Results: Twenty-four patients (mean age, 8.22 ± 1.06 years; 7 males and 17 females) were included in the SBU group, and 25 patients (mean age, 8.30 ± 0.99 years; 11 males and 14 females) were included in the comparison group. After a 12-month follow-up, the overbite increased approximately 4 mm in both groups (MD, -0.11 mm; 95% CI, -1.03 to 0.80). Means of anterior dentoalveolar vertical development ranged from 2.24 mm (S group) to 2.49 mm (SBU group) and from 1.31 mm (SBU group) to 1.55 mm (S group) for the maxilla (MD, -0.24 mm; 95% CI, -0.91 to 0.44) and mandible (MD, 0.29 mm; 95% CI, -0.39 to 0.96), respectively. The maxillary intermolar distance decreased in the SBU group and increased in the S group (MD, -0.48 mm; 95% CI, -0.92 to -0.03). The mandibular intermolar distance increased in the SBU group and decreased in the comparison group (MD, 0.26 mm; 95% CI, 0.004-0.52). Plaque accumulation around the spurs was observed in some patients., Conclusions: Both protocols demonstrated similar improvements in the AOB with similar effects on the dental arches. The SBU group showed a slight decrease in the maxillary intermolar distance and a slight increase in the mandibular intermolar distance, whereas opposite changes were observed for the S group., Registration: This trial was registered at Clinicaltrials.gov (Identifier NCT03702881)., Protocol: The study protocol was not published., Funding: This work was supported by the São Paulo Research Foundation (FAPESP) grants nos. 2017/06440-3, 2018/05238-9, and 2018/24003-2; and financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES), Finance Code 001., (Copyright © 2021 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to three-dimensionally compare the root angulation changes after orthodontic traction of buccally versus palatally maxillary impacted canines (MICs)., Material and Methods: This retrospective study included patients from a private dental office of both sexes, older than 12 years, with at least one unilateral or bilateral buccal or palatal MIC, no loss of permanent teeth, with complete apical closure at the beginning of traction, and with CBCTs taken at pretreatment (T 0 ) and after orthodontic traction (T 1 ). The sample was divided in two groups according to their impaction site: buccal versus palatal. In all the scans, the MIC was segmented and the root angulation changes after traction were evaluated. The assessment included the sigma angle (projected on the XZ plane or coronal tomographic view), the delta angle (projected on the XY plane or axial view) and the epsilon angle (projected on the YZ plane, or sagittal view). Intragroup comparisons were performed with Wilcoxon signed-rank tests. Intergroup comparisons were performed with t-tests or Mann-Whitney U tests. Finally, the influence of MIC characteristics on the measured angles were evaluated with multiple linear regression analyses (α=0.05)., Results: Thirty-three patients (16 men, mean age: 20.38; 17 women, mean age 18.37) with forty-five orthodontically treated MIC (19 buccal versus 26 palatal) were finally included. The palatal MICs showed greater mediolateral uprighting than the buccal MICs, root displacement towards the midsagittal plane, as demonstrated by the sigma angle (palatal group: 37.58±15.08°; buccal group: 29.17±31.15°; P=0.164) and delta (palatal group: -76.90±26.55°; buccal group: -30.56±41.67°; P<0.001)angle changes. The buccal MICs showed greater anteroposterior uprighting, anterior root displacement, as demonstrated by the epsilon angle (palatal group: -4.63±12.37°; buccal group: -25.96±17.79°; P<0.001)., Conclusions: Mediolateral and anteroposterior root angulation show significant differences after traction between buccal and palatal MICs. Palatal MICs showed greater medial root displacement while buccal MICs showed greater anterior root displacement. This condition should be considered for better planning of traction and orthodontic finishing., (Copyright © 2021 CEO. Published by Elsevier Masson SAS. All rights reserved.)