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The present Canadian position paper contains recommendations for the management by dentists of sleep-disordered breathing in adults with the use of oral appliances (OAs) as a treatment option for snoring and obstructive sleep apnea (OSA). The recommendations are based on literature reviews and expert panel consensus. OAs offer an effective, first-line treatment option for patients with mild to moderate OSA who prefer an OA to continuous positive airway pressure (CPAP) therapy, or for severe OSA patients who cannot tolerate CPAP, are inappropriate candidates for CPAP or who have failed CPAP treatment attempts. The purpose of the present position paper is to guide interdisciplinary teamwork (sleep physicians and sleep dentists) and to clarify the role of each professional in the management of OA therapy. The diagnosis of OSA should always be made by a physician, and OAs should be fitted by a qualified dentist who is trained and experienced in dental sleep medicine. Follow-up assessment by the referring physician and polysomnography or sleep studies are required to verify treatment efficacy. The present article emphasizes the need for a team approach to OA therapy and provides treatment guidelines for dentists trained in dental sleep medicine. Many of the dentists and sleep physicians who contributed to the preparation of the present article are members of the Canadian Sleep Society and the authors reached a consensus based on the current literature.

Custom-made mandibular advancement devices are an effective treatment option for snoring, upper airway resistance syndrome, and obstructive sleep apnea (OSA). Evidence-based data indicates their efficacy, and international sleep societies recommend oral appliance (OA) therapy for patients with sleep-related breathing disorders. The following position paper by the German Society of Dental Sleep Medicine (DGZS) is to guide the interdisciplinary team (sleep physician and sleep disorder dentist) in detail when to prescribe oral appliances. This position paper supports the responsible use of OA as an effective treatment option for patients with sleep-related breathing disorders. The paper advises of proper indication regarding OSA severity, body mass index (BMI), and dentition. It emphasizes the interdisciplinary approach of oral appliance therapy and suggests treatment under the guidance of dentists trained in dental sleep medicine.

The fixed orthodontic measures taken induce significant stress to the gingival growth process during arch wire maneuvers of aligning and leveling. We observed, for a period of one to four years, fixed orthodontic devices in 80 human subjects. From these, we selected 44 subjects (22 women and 22 men) where the inflammatory process exhibited following the orthodontic fixed treatment, and with vacuum-formed orthodontic retainers (VFR) succeeding to fixed treatment. Samples were collected from each patient and histological and immunohistochemical (IHC) methodology was made to analyze the cytoarchitecture. Statistics were made after one-way analysis of variance (ANOVA), with the Bonferroni's correction. The IHC examination performed in the early stage revealed the presence in the inflammatory infiltrate of CD8-type T-lymphocytes, and of dendritic cells in large numbers. The examination performed in the late stage revealed the presence in the inflammatory infiltrate of CD20-type B-lymphocytes, which are mature cells capable of immunoglobulin synthesis, their activation being an important step in the maturation of the antibody response. The stress generated by arch wires in both genders was significantly higher than in the case of VFR. This observation was pointed out also by the cytohistological investigation outcome but was also based on an original scale conceived by our research team, following gingival hyperplasia evaluation. Also, with statistical significance, the comparative obtained values for men (p=0.01) and for women (p=0.001) illustrate clinical observations, allowing to affirm that, in our case, men were more stressed in bearing arch wire devices (AWD) and VFR, in comparison with women.

SUMMARY The aim was to assess the views and practice of Croatian orthodontists concerning retention protocols. A total of 150 questionnaire copies were distributed, of which 92 were validly completed. The survey included sociodemographic characteristics, practices of informing patients about retention options, commonly used appliances, and reasons for choosing a particular type of retention and treatment duration. Orthodontists informed patients about retention mostly verbally, the retention period was 3-5 years, the choice of method depended on the malocclusion (76%), and the protocol was influenced by clinical experience of the orthodontist (39%). The most commonly used appliance in the maxilla was the vacuum-formed retainer (52%), whereas a combination of fixed and removable retainers was most common in the mandible (34%). Modus of acquiring knowledge, biological reasons (malocclusion type, oral health, treatment outcome, and growth) and the patient’s wishes were not a predictor of retention duration or recall frequency. With an increase in orthodontic experience, the duration of retention decreased and orthodontists were more likely to change the duration of retention (p=0.001), as well as the type of retention appliance (p

Since the introduction of the Tooth Positioner (TP Orthodontics) in 1944, removable appliances analogous to clear aligners have been employed for mild to moderate orthodontic tooth movements. Clear aligner therapy has been a part of orthodontic practice for decades, but has, particularly since the introduction of Invisalign appliances (Align Technology) in 1998, become an increasingly common addition to the orthodontic armamentarium. An internet search reveals at least 27 different clear aligner products currently on offer for orthodontic treatment. The present paper will highlight the increasing popularity of clear aligner appliances, as well as the clinical scope and the limitations of aligner therapy in general. Further, the paper will outline the differences between the various types of clear aligner products currently available.

Background: Clear aligner treatment (CAT) has been cited as a safe and comfortable orthodontic procedure for adult patients. However, the available evidence is scarce. Objective: To perform a systematic review of the existing literature in order to assess periodontal health during CAT. Search methods and selection criteria: Pubmed, Pubmed Central, National Library of Medicine’s Medline, Embase, Cochrane Central Register of Controlled Clinical trials, Web of Knowledge, Scopus, Google Scholar, and LILACS were searched from January 1945 to September 2014 to identify all peer-reviewed papers potentially relevant to the review. Data collection and analysis: After duplicate selection and extraction procedures, the risk of bias was assessed according to the Centre for Reviews and Dissemination criteria, and a 3-point grading system, as described by the Swedish Council on Technology Assessment in Health Care (SBU), was used to rate the methodological quality of the selected papers. A PICOS table was used for data extraction. Results: Five relevant articles were selected from the 1247 identified articles. The level of evidence was moderate for all the studies. A significant improvement of the periodontal health indexes was revealed, in particular when CAT was compared to fixed appliances. No periodontal CAT adverse effects were observed in the selected studies. Conclusions: Periodontal health indexes were significantly improved during CAT. The results of this review should be interpreted with some caution because of the number, quality, and heterogeneity of the included studies.

Made available in DSpace on 2020-12-12T01:48:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01 Aim: This paper presents a prototyped surgical guide for placement of MARPE-mini-implant-assisted rapid palatal expander. Background: Investigations conducted in the last decades have increased the technological resources used in orthodontics. This scientific advance applies to several clinical procedures, including the planning of devices used in guided surgeries, using computed tomography images and intraoral scanning. Case description: This case report presents maxillary expansion in an adult patient (18 years and 5 months), using the MARPE technique, by virtual planning and fabrication of a surgical guide (laser-printed on a 3D printer MoonRay D225-SprintRay, 2014), after merging of 3 files: digital file of the expander (. stl), computed tomography of the suture, and intraoral scanning of the patient, using the planning software NemoStudio (version 20122, 16.50.0.56). Conclusion: Fabrication of a surgical guide for the MARPE technique provides an accurate transfer of the virtual planning to the surgical procedure. It allows three-dimensional orientation of the expander position and perforations of mini-implants, which are necessary to establish anchorage in areas with sufficient bone, assuring the system stability and a successful procedure. Clinical significance: The mini-implant assisted rapid palatal expansion (MARPE) has been investigated as a promising option for correction of malocclusion related with maxillary atresia in adult patients and is an option to orthognathic surgery. Digital treatment planning is fundamental to establish individual, reproducible, and accurate parameters, as in the present case, which evidenced significant benefits in both occlusal and respiratory aspects. Department of Orthodontics School of Dentistry at Araraquara UNESP São Paulo State University Department of Oral Radiology School of Dentistry Catholic University of Brasilia Department of Orthodontics Planalto University Center School of Dentistry Department of Orthodontics School of Dentistry at Araraquara UNESP São Paulo State University

The aim of this paper is to illustrate the use of a modified vertical holding appliance (G-VHA) to obtain the vertical control of maxillary molars and tongue stimulation in order to achieve a transverse activation in growing patients with dental open bite without the patient's compliance.The G-VHA is a modified trans-palatal bar with a resin pad covering the Omega central loop and two adjunctive lateral loops to ensure the bar flexibility. The G-VHA is designed to direct the force of the tongue against the upper molars to generate intrusion and at the same time to stimulate and re-educate the tongue. Two cases of dental open bite in growing patients are illustrated. Both patients were successfully treated, and the open bite was fully corrected thanks to molar intrusion, following counterclockwise rotation of the mandible and tongue correction. Finishing of alignment was performed in phase II of the treatment with conventional appliances.The G-VHA proved to be effective in controlling the vertical position of maxillary molars promoting the counter-clockwise rotation of the mandible and stimulating a different tongue posture.

The demand for orthodontic treatment in adults has been increasing. However, these patients often require a multidisciplinary approach, due to the lack of posterior teeth, requiring additional anchorage. The skeletal anchorage by endosseous implants is an option, since they may be used later for prosthetic rehabilitation. The application of immediate load on these appliances for orthodontic movement may reduce the costs and total treatment time. This paper discusses the utilization of endosseous dental implants with immediate load for absolute anchorage for orthodontic movement, with later utilization for prosthetic rehabilitation. RESUMO A demanda por tratamento ortodôntico em pacientes adultos tem sido cada vez maior. Entretanto, esses pacientes frequentemente exigem um tratamento multidisciplinar, devido às ausências de dentes posteriores, necessitando de ancoragem adicional. A ancoragem esquelética usando implantes osseointegrados apresenta-se como alternativa, uma vez que eles serão posteriormente utilizados para reabilitação protética. A aplicação de carga imediata sobre esses dispositivos, para movimentação ortodôntica, pode reduzir custos e o tempo total de tratamento. O presente artigo tem como objetivo discutir o emprego de implante dentário osseointegrado, com carga imediata, como ancoragem absoluta para movimentação ortodôntica e, posteriormente, utilizado para reabilitação protética.

The purpose of this paper was to emphasize the importance of the orthodontic setup in treatment planning for skeletal Class III malocclusion correction in an adult patient with moderate lower anterior crowding and anterior crossbite associated with two supernumerary lower incisors.

Early correction of developing class III malocclusions remains a complex challenge. Treatment approaches for these young patients have been directed at growth modification. Encouraging outcomes have been reported with the use of Class III functional appliances including reverse twin block (RTB) appliance. The present paper tries to provide an insight into RTB appliance used for successful interceptive management of developing class III malocclusion in two children. RTBs were fabricated with bite registered in the position of maximum possible retrusion of mandible with interincisal clearance of 2 mm and vertical clearance of 5 mm in the buccal segments. Anterior crossbite was corrected, and there was a marked improvement in facial appearance of the children. RTB can be a viable and effective functional appliance treatment modality for early management of developing class III malocclusion.

Objective: To compare changes in WALA ridge and mandibular dental arch dimensions in orthodontic patients treated with a passive self-ligating system and conventional appliances. Design: Original paper. Setting: Orthodontic department at Inga University Center, Maringá, PR, Brazil. Materials and Methods: Pretreatment (T1) and posttreatment (T2) dental casts of 60 patients with Class I malocclusion treated with slight to moderate crowding that were divided into two groups. Group 1: 30 patients treated with a passive self-ligating system, at a mean initial age of 17.68 years and mean treatment time of 2.31 years. Group 2: 30 patients treated with conventional appliances, at a mean initial age of 19.23 years and mean treatment time of 2.56 years. Measurements were taken using a digital caliper directly on pre and posttreatment dental casts to evaluate the transversal dimension behavior of the mandibular dental arch and the WALA ridge width. Results: Self-ligating group presented an increase in WALA ridge width and mandibular transversal dimensions significantly greater than the conventional group, with the exception of intermolar cusp tip distance and intercanine WALA ridge. There was no statistically significant difference between the groups. There was also observed a significantly greater increase of the transversal buccal axis dimensions in the premolar area when compared to the WALA ridge increase in both groups. Conclusions: Treatment with a passive self-ligating system resulted in a significantly greater increase of the WALA ridge width and mandibular arch dimensions when compared to conventional appliance.

Class Ⅱ malocclusion is a common orofacial deformity that could harm the facial esthetics and oral function. Two-stage treatment strategy always applies to functional and skeletal (mild and moderate) class Ⅱ malocclusion with man-dibular retrognathism in teenagers. Traditional functional orthopedic appliances are less comfortable and inconvenient to correct the dental arches, making the treatment duration long. With the rapid progress of digital technology and material science, functional clear aligners that offer comfort have emerged. Functional clear aligners can combine orthopedic and orthodontic treatments to correct the jaw relationship and align the dental arch, thereby shortening the treatment duration. This paper emphasizes the treatment key points, and clinical experience of using functional clear aligners.Ⅱ类错牙合是一种常见的牙颌畸形，对青少年颜貌美观和口颌系统功能有明显的影响。对于青少年以下颌后缩为主的功能性和轻中度骨性Ⅱ类错牙合，建议采用双期矫治。传统的功能矫治器舒适度低，不方便进行牙列的调整，疗程较长；随着数字化技术和材料科学的快速发展，隐形功能矫治器应运而生。隐形功能矫治器佩戴舒适，可以将矫形治疗和矫治治疗有机地结合在一起，在调整颌骨关系的同时对错位牙进行矫正，提高矫治效率，缩短治疗时间。本文结合典型病例，简单介绍使用隐形功能矫治器矫治青少年Ⅱ类错牙合畸形的矫治要点和治疗体会。.

Made available in DSpace on 2022-04-29T08:38:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Introduction: This paper aims to evaluate the effect of tube height on uprighting a mandibular second molar with a continuous arch, specifically the main effects on the molar tube and the side effects on the second premolar bracket. Methods: Slot brackets (0.18-in) and tubes were passively bonded from the left second molar to the right second premolar of the patient's cast and fixed to an orthodontic force tester. A mesially tipped second molar along with its tube was positioned at 5 different heights in relation to the bracket slots of the remaining appliance: 2 mm below (group −2), 1 mm below (group −1), leveled (group 0), 1 mm above (group 1) and 2 mm above (group 2). Each group had 10 different 0.016 × 0.022-in superelastic nickel-titanium wires tied one at a time to the appliance to register the vertical forces (Fz) and tipping moments (Mx) produced at the molar tube and the premolar bracket, statistically. Analysis of variance was used to identify differences of load among the groups for wire response to the position of the tube in relation to the other brackets’ slots. Results: As the molar tube was positioned more occlusally, Fz and Mx decreased at the molar tube from 1.31 N to 0.75 N and 13.98 N.mm to 11.84 N.mm, respectively, whereas at the premolar bracket, Fz and Mx decreased from 1.52 N to 0.88 N and 8.77 N.mm to 1.05 N.mm, respectively. Conclusions: In all groups, the load system at the molar tube (the main effects) registered a distal tipping moment and an extrusive force, whereas at the premolar bracket, the load system (side effects) included a distal tipping moment and an intrusive force. As the tube moved occlusally, the extrusive force and the uprighting moment decreased, along with the side effects at the premolar bracket. Attempting to bond the molar tube more occlusally (within reasonable intraoral dimensions) when trying to upright a molar does not appear to be sufficient to keep a molar from extruding. Department of Orthodontics Faculdade de Odontologia de Araraquara Universidade Estadual Paulista Private practice Department of Orthodontics Faculdade de Odontologia de Araraquara Universidade Estadual Paulista

Background and Objectives: Palatal expansion is a common orthodontic technique able to increase the transverse changes for subjects with constricted maxillary arches. The aim of the present investigation was to evaluate through a systematic review the tomography effectiveness of different palatal expander approaches. Materials and Methods: The database used to perform the screening and determine the eligibility of the clinical papers was PubMed (Medline). Results: The database search included a total of 284 results, while 271 articles were excluded. A total of 14 articles were included for the qualitative assessment. Conclusions: The effectiveness of the present studies reported that skeletal expansion was a useful approach to increase the transverse changes for subjects with constricted maxillary arches.

The publication of the three-paper series on the effects of two slot sizes on treatment parameters in this issue, targets a topic, which has attracted a lot of discussion based primarily on anecdotal evidence. The conclusive evidence contribute to the lack of variation of treatment variables with slot size selection, clarifies one of the traditional beliefs on this issue; several others still hold strong however. This commentary has the objective of highlighting some points, which could be taken into consideration in interpreting the results of this three-part trial.

The aim of this article is to describe the use of a titanium TSME appliance for patients with allergy to resin and nickel. We aim to highlight the optimal way to avoid problems such as stomatitis and peri-labial dermatitis, which generally appear in patients who use traditional orthodontic appliances made in acrylic resin and steel.The construction of a titanium appliance is described and a case treated with it is reported.The titanium TSME presented in this paper has excellent biocompatibility due to its ability to form superficial oxides, which prevent oxidation and thus corrosion.The non-allergic properties of titanium allow to propose it as an alternative in patients with a long-term history of allergic reactions to nichel.

With so many disciplines of both medicine and dentistry involved in the treatment of obstructive sleep apnea (OSA), several forms of therapy are available. The orthodontist is rarely considered when the diagnosis of chronic obstructive sleep apnea (OSA) is delivered. However, the scope of orthodontic care today is much broader than the mere alignment of teeth. While the current gold standard for OSA care remains continuous positive air pressure (CPAP), the patient may be given a prescription for an intra-oral sleep appliance. When orthodontists work in concert with their medical colleagues to provide a sleep appliance, several considerations must be made including the evidence regarding oral appliance efficacy. For some patients, oral appliances are highly successful; however, even for responsive patients, there are risks associated with oral appliance therapy. The aim of the paper was to present a critical review of the current level of evidence for the use of oral appliances in the treatment of OSA. A substantial number of publications ranging from case reports, uncontrolled and controlled case series, prospective randomized studies, and even a small number of systematic reviews were available. The existing systematic reviews were based on either a limited number of prospective studies with limited numbers of patients or in some cases were based on subjective data only. As a result, a narrative review of the literature was performed that discusses objective clinically testable criteria and recent developments that may aid future research investigations.

INTRODUCTION: The finishing and polishing phases are essential to improve smoothness and shining on the surface of acrylic resins used to make removable orthodontic appliances. A good surface finishing reduces roughness, which facilitates hygiene, prevents staining and provides greater comfort to the patients. OBJECTIVE: The aim of this paper was to analyze the changes on surface morphology of acrylic resins during finishing and polishing phases. METHODS: Thirty discs (10 mm in diameter and 5 mm in length) were made with acrylic resin and randomly divided into ten groups. The control group did not receive any treatment while the other groups received gradual finishing and polishing. The last group received the entire finishing and polishing procedures. Surface morphology was qualitatively analyzed through scanning electron microscopy and quantitatively analyzed through a laser profilometer test. RESULTS: The acrylic resin surfaces without treatment showed bubbles which were not observed in the subsequent phases. Wearing out with multilaminated burs, finishing with wood sandpaper and finishing with water sandpaper resulted in surfaces with decreasing irregularities. The surfaces that were polished with pumice and with low abrasive liquids showed high superficial smoothness. CONCLUSION: Highly smooth acrylic resin surfaces can be obtained after mechanical finishing and polishing performed with multilaminated burs, wood sandpaper, water sandpaper, pumice and low abrasive liquids. INTRODUÇÃO: as etapas de acabamento e polimento são essenciais para a obtenção de lisura e brilho da superfície de resinas acrílicas utilizadas na confecção de aparelhos ortodônticos. O bom acabamento da resina facilita a higiene, previne o manchamento e propicia maior conforto ao paciente. OBJETIVO: o objetivo desse trabalho foi analisar as alterações na morfologia superficial de resinas acrílicas (Clássico, São Paulo) durante as etapas do acabamento e polimento mecânico. MÉTODOS: foram confeccionados 30 discos (10mm de diâmetro e 5mm de altura) de resina acrílica autopolimerizável, que foram divididos aleatoriamente em dez grupos. O grupo controle não recebeu nenhum tratamento. Os demais grupos receberam acabamento e polimento graduais. O último grupo recebeu todo o tratamento de acabamento e polimento. A morfologia superficial foi avaliada qualitativamente por microscopia eletrônica de varredura e quantitativamente pela análise da rugosidade superficial. RESULTADOS: as superfícies de resina acrílica sem tratamento apresentaram bolhas, as quais não foram observadas nas fases subsequentes. O desgaste com fresa multilaminada seguido de acabamento com lixa de madeira e lixa d'água produziram superfícies com irregularidades decrescentes. As superfícies polidas com branco de Espanha e líquido de baixa abrasividade (Kaol) apresentaram bom acabamento superficial. CONCLUSÃO: é possível obter resina acrílica com alta lisura superficial após acabamento e polimento mecânico com fresas, lixas de madeira, lixas d'água, branco de Espanha e líquidos de baixa abrasividade (Kaol).

Timing of orthodontic treatment, especially for children with developing class III malocclusions, has always been somewhat controversial, and definitive treatment tends to be delayed for severe class III cases. Developing class III patients with moderate to severe anterior crossbite and deep bite may need early intervention in some selected cases. Class III malocclusion may develop in children as a result of an inherent growth abnormality, i.e. true class III malocclusion, or as a result of premature occlusal contacts causing forward functional shift of the mandible, which is known as pseudo class III malocclusion. These cases, if not treated at the initial stage of development, interfere with normal growth of the jaw bases and may result in severe facial deformities. The treatment should be carried out as early as possible for permitting normal growth of the skeletal bases. This paper deals with the selection of an appropriate appliance from the various current options available for early intervention in developing class III malocclusion through two case reports.

The purpose of this study was to compare Prostaglandin E(2) (PGE(2)) levels in gingival crevicular fluid (GCF) of young adults with maxillary constriction during tooth- and bone-borne expansion. Thirty patients, 15 females and 15 males, with a mean age of 17.3 +/- 2.8 years were divided into three groups. Group I consisted of 10 patients, five females and five males, treated by transpalatal distraction (TPD) as a bone-borne device, group II 10 patients, five females and five males, with a Hyrax appliance as a tooth-borne device, and a control group of 10 patients, five females and five males, without any expansion appliances. GCF samples were collected with filter paper strips at six observation periods in order to evaluate the effect of heavy orthopaedic forces in both groups. In group II, the samples were additionally collected at two pre-treatment time points in order to evaluate the effect of the forces generated by the separators. An automated enzyme immunoassay was used to measure PGE(2) in the GCF. The differences within the groups were evaluated with a pairwise t-test and the differences between the groups were determined by the Mann-Whitney U-test. The mean PGE(2) level was significantly elevated on day 4 after placement of the separators in group II (P0.05). The PGE(2) values in group II were significantly different to those in group I and the controls at all observation periods. Lower PGE(2) levels were observed in group I compared with group II and the controls. Expansion using the TPD method could potentially enhance the prognosis of the teeth by inducing more skeletal dental changes when compared with the Hyrax appliance.

This paper describes the treatment of a female patient, aged 23 years and 5 months, with a Class II division 1 malocclusion, who showed severe anterior protrusion and lower anterior crowding. Specially-designed orthodontic mini-implants were placed bilaterally in the interdental space between both the upper and the lower posterior teeth. Both lower first molars showed severe apical lesions. Therefore, the treatment plan consisted of extraction of both upper first premolars and lower first molars, en masse retraction of the upper six anterior teeth, lower anterior alignment, and protraction of all the lower molars. C-implants® were used as substitutes for maxillary posterior anchorage teeth during anterior retraction and as hooks for mandibular molar protraction. The correct overbite and overjet were obtained by intruding and retracting the upper six anterior teeth into their proper positions. The dentition was detailed using conventional orthodontic appliances. The upper C-implants contributed to an improvement in facial balance, and the lower C-implants made it possible to protract the lower second and third molars with less effect on the axis of the lower anterior teeth. The active treatment period was 29 months and the patient's teeth continued to be stable 11 months after debonding.

Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring.The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations.1. We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) 2. When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) 3. We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) 4. We suggest that qualified dentists provide oversight—rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE) 5. We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE) 6. We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits—as opposed to no follow-up—with a qualified dentist and a sleep physician. (GUIDELINE).The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline reflects the state of knowledge at the time of publication and will require updates if new evidence warrants significant changes to the current recommendations.

This paper aims to explore the antibacterial property of nano Ag/TiO2 coating bracket for the common bacteria in oral cavity, and discuss its biocompatibility. Micro morphology in the surface of nano Ag/TiO2 coating bracket was detected by scanning electron microscope (SEM), and surface roughness of ordinary mental bracket, nano TiO2 coating bracket and nano Ag/TiO2 coating bracket were measured. First, antibacterial property of nano Ag/TiO2 coating bracket on the common bacteria in oral cavity was studied by sticking membrane method. Secondly, bonding strength of nano TiO2 coating and nano Ag/TiO2 coating bracket in groups were detected by scratching test. The result showed that, the synthetic nano Ag/TiO2 coating was nanogranular films with rigorous organizational structure, presenting as smooth and clean surface, and antibacterial rate of nano Ag/TiO2 coating for the common bacteria in oral cavity for 20 min was more than 79% in the dark. All the findings suggested that, nano Ag/TiO2 coating bracket not only has antibacterial effect but also has good biocompatibility, therefore, it can satisfy the clinical request of orthodontic treatment.

Every treatment in the dental specialty has its own set of complications, Orthodontic therapy being no exception. Such a problem during the course of treatment puts the specialist in a dilemma as to whether to continue or stop the treatment. One such case in which during headgear therapy, a rare complication such as alopecia was encountered has been dealt with in this paper. This case report shows its effective management while still continuing treatment, thus leading to the desired result. It emphasizes on the importance of maintaining a balance between the benefits and risks of a treatment. Clinical relevance The use of headgear can lead to the rare complication of alopecia and the clinician should be aware of it. Objective The reader should understand the psychological implications of alopecia and also to carry out the treatment after assessing the risk/benefit ratio. How to cite this article Premkumar S, Vidya K. Pressureinduced Alopecia from Orthodontic Headgear. J Contemp Dent Pract 2013;14(5):954-956.

The aim of this paper is to familiarize the readers with some of the clinical considerations necessary to ensure successful use of mid-palatal implants. Both surgical and technical aspects will be discussed along with a description of impression techniques used.

Treatment effects of lip bumpers alone include flaring of the mandibular incisors, distalization and uprighting of the mandibular first molars, and buccal expansion of the canines, premolars, and molar. Lip forces are transmitted through this appliance onto the molars. Moreover the lip bumper is able to derotate, expand or constrict, upright and reinforce the anchorage whereas torque control is lacking. Aim of this paper is the presentation of a new type of lip bumper that allows the molar torque control.

INTRODUCTION: Orthodontics, just as any other science, has undergone advances in technology that aim at improving treatment efficacy with a view to reducing treatment time, providing patients with comfort, and achieving the expected, yet hardly attained long-term stability. The current advances in orthodontic technology seem to represent a period of transition between conventional brackets (with elastic ligatures) and self-ligating brackets systems. Scientific evidence does not always confirm the clear clinical advantages of the self-ligating system, particularly with regard to reduced time required for alignment and leveling (a relatively simple protocol), greater comfort for patients, and higher chances of performing treatment without extractions - even though the number of extractions is more closely related to patient's facial morphological pattern, regardless of the technique of choice. Orthodontics has recently and brilliantly used bracket individualization in compensatory treatment with a view to improving treatment efficacy with lower biological costs and reduced treatment time. OBJECTIVE: This paper aims at presenting a well-defined protocol employed to produce a better treatment performance during this period of technological transition. It explores the advantages of each system, particularly with regards to reduced treatment time and increased compensatory tooth movement in adult patients. It particularly addresses compensable Class III malocclusions, comparing the system of self-ligating brackets, with which greater expansive and protrusive tooth movement (maxillary arch) is expected, with conventional brackets Capelozza Prescription III, with which maintaining the original form of the arch (mandibular arch) with as little changes as possible is key to yield the desired results. INTRODUÇÃO: a Ortodontia passa, como toda ciência, por constantes evoluções tecnológicas que buscam aumentar a efetividade da abordagem terapêutica, visando a diminuição do tempo de tratamento, o aumento do conforto para os pacientes, bem como a obtenção da tão almejada, e pouco alcançada, estabilidade em longo prazo. O estágio atual de desenvolvimento tecnológico da Ortodontia representa, ao que tudo indica, uma fase de transição entre os sistemas convencionais de ligação (com módulos elásticos) e os chamados autoligáveis. As evidências científicas nem sempre consubstanciam a clara percepção clínica das vantagens desse sistema, no que diz respeito a um menor tempo de alinhamento e nivelamento, uma relativa simplificação técnica, maior conforto para os pacientes, além do aumento da capacidade de tratamento sem extrações - embora essa indicação esteja mais ligada à avaliação do padrão morfológico facial, e menos a qualquer escolha técnica. Desde um passado recente e não menos brilhante, a Ortodontia vem utilizando a individualização de braquetes para tratamentos compensatórios, buscando aumentar a efetividade da abordagem terapêutica, com menores custos biológicos e menor tempo de tratamento. OBJETIVO: o presente artigo tem como objetivo apresentar um protocolo bem definido de melhor aproveitamento dessa fase de transição tecnológica, buscando explorar o que cada sistema tem de melhor, principalmente sob a óptica da redução do tempo de tratamento e aumento da capacidade de movimentação dentária compensatória em pacientes adultos. Especificamente, serão abordadas as más oclusões de Classe III compensáveis, usando o sistema de braquetes autoligáveis onde se deseja maior capacidade de movimento expansivo e protrusivo (arcada superior) e braquetes convencionais Prescrição III Capelozza(r) onde a manutenção da forma com mínima mudança (arcada inferior) é imprescindível para a obtenção dos resultados almejados.

Non-extraction treatment has gained popularity for corrections of mild-to-moderate class II malocclusion over the past few decades. The distalization of maxillary molars is of significant value for treatment of cases with minimal arch discrepancy and mild class II molar relation associated with a normal mandibular arch and acceptable profile. This paper describes our experience with a 16-year-old female patient who reported with irregularly placed upper front teeth and unpleasant smile. The patient was diagnosed to have angles class II malocclusion with moderate maxillary anterior crowding, deep bite of 4 mm on a skeletal class II base with an orthognathic maxilla and retrognathic mandible and normal growth pattern. She presented an ideal profile and so molar distalization was planned with the first-class appliance. Molars were distalised by 8 mm on the right and left quadrants and class I molar relation achieved within 4 months. The space gained was utilised effectively to align the arch and establish a class I molar and canine relation.

The authors have been dealing with disorders of the masticatory organ (CMD) for several decades and they published their experience and summarized findings that they have gained from over 2,000 cases. They gave a summary of masticatory organ dysfunction diagnostics in 3rd issue of Fogorvosi Szemle in 2011. In their current paper they discuss the treatment of masticatory organ dysfunctions (CMD) according to the logic of diagnostic algorythm and they present it to the practising dentist. They would like to emphasize that it is not allowed to indicate any treatment especially an irreversible one, without a diagnosis. The cause of the disease can very often be identified or specified after the symptom relieving treatment. After summarizing the general treatment principles depending on the functional condition of the masticatory organ, they give a detailed explanation of systematic functional therapy, i.e., symptomatic treatment or medical treatment, physiotherapy, occlusal splint therapy and the definitive treatment that follows (such as occlusal adjustment, prosthetic rehabilitation, orthodontics and surgical intervention). They classify the occlusal instruments (splint), which are often misinterpreted or not used in the proper way in practice (and bibliography), according to indications. They outline some orthodontic anomalies in connection with the masticatory organ: on the one hand when the patient who undergoes an orthodontic treatment has a latent or manifest masticatory organ dysfunction (CMD), on the other hand when the dysfunction appears during the orthodontic treatment. Among the definitive treatment principles they emphasize the gnathological aspects of prosthetic rehabilitation. They draw attention to the maintenance therapy of patients suffering from masticatory organ dysfunction.

This paper looks at the role of mandibular advancement splints in the management of obstructive sleep apnoea, as part of a multidisciplinary approach. Clinical guidance is provided on the rationale for use, patient selection, design features and the associated risk to benefit ratio.