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Introduction: The long pathway that the canines take as they emerge into the maxillary arch makes them vulnerable to disruption during their natural emergence time. The process of planning treatment for impacted maxillary canine (IMC) presents significant challenges, underscoring the need for careful consideration and expertise., Objective: The aim of this article was to shed light on these complexities by discussing clinical case studies involving IMC, providing insights into the intricacies of their management., Conclusions: The management of IMC within orthodontics presents a multifaceted challenge that include the necessity for precise diagnostic processes, prudent use of cone beam computed tomography (CBCT), the strategic selection between open and closed exposure techniques, a in-depth understanding of the specific orthodontic biomechanics involved, and a keen awareness of potential adverse outcomes such as ankylosis, prolonged treatment times, root resorption, and additional complications.

Objective: To assess whether there is an association between an individual's sex and social judgements made by lay persons regarding untreated cleft lip., Materials and Methods: Lay individuals over 18 years old were recruited through an application to respond online to two questionnaires: a sociodemographic survey and the Brazilian Version of Lay Persons' Social Judgements about Cleft-lip Scale (B-LSojCleft-S). B-LSojCleft-S comprises 14 items evaluating social judgements made by laypersons concerning different types of untreated cleft lips in teenagers. The 14 items are linked to 8 images featuring untreated cleft lips and 1 image without a cleft (control). Higher scores represented more favourable social judgements. Independent samples t-test, paired, and multiple linear regression were conducted (P < 0.05). The study assessed judgements of untreated cleft lips in male and female adolescents using the B-LSojCleft-S., Results: The mean age of the 217 participants was 37.78 ± 12.39 years, predominantly women (72.7%), married (47.7%), with a monthly income below three minimum wages (35.6%) in the majority of cases. Significantly higher social judgement scores were observed in the control group (no cleft) compared to any type of cleft (P < 0.001), with similar scores obtained for the same types of clefts with female or male images (P > 0.05). The participant's sex is associated with social judgement scores (F [1, 214] = 6.318, P = 0.013; adjusted R 2  = 0.024), with females making more favourable judgements than males (P < 0.05)., Conclusions: Individuals with cleft lips receive more negative social judgement scores, regardless of their own sex. Women make better social judgements than men., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: We evaluated whether the use of botulinum neurotoxin type A (BTX-A) in masticatory muscles influences tooth movement and bone remodeling., Design: Seventy-seven male Wistar rats were allocated to the groups: S - Saline (n=20); SM - Saline with movement (n=20); BT - Botulinum toxin (n=18); BTM - Botulinum toxin with movement (n=19). On day 1, 0.02 mL of sterile 0.9 % saline was administered to groups S and SM and BTX-A (1 U in 0.02 mL of saline) to groups BT and BTM, in the masseter and temporal muscles laterally. On day 30, a nickel titanium spring was installed to move the first maxillary molar and euthanasia was performed on days 32 and 51. Tooth displacement, maxillary and mandibular bone volumes, collagen neoformation, bone and root resorptions, and masseter morphometry were assessed. Statistical analysis was conducted (p < 0.05)., Results: A higher percentage of type I collagen was observed in the BT than in the S group on day 51 and lower mass, length, and diameter of the masseter fibers in BT and BTM (p < 0.05). Tooth displacement, bone volume, bone and root resorptions, hyaline area, and masseter height showed no difference among groups with and without BTX-A, regardless of tooth movement (p > 0.05)., Conclusions: BTX-A did not interfere with tooth displacement, bone volume, and dental and periodontal tissues related to tooth movement in rats; it increased mature collagen in animals without tooth movement; and it caused a decrease in the mass, length, and diameter of the masseter fibers., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Elisa Souza Camargo reports statistical analysis was provided by Pontifical Catholic University of Parana, School of Medicine and Life Sciences. If there are other authors, they 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 © 2024. Published by Elsevier Ltd.)

Objective: To evaluate the effect of rapid palatal expansion (RPE) using Haas-type expanders on children's oral health-related quality of life (OHRQOL) and compare said effect with that previously reported for the use of Hyrax-type expanders., Materials and Methods: Forty participants aged 8-10 years with transverse maxillary deficiency were treated using Haas appliances. OHRQOL was measured using the CPQ 8 - 10 before RPE, during RPE (T 1 ), at the end of RPE (T 2 ), and 1 month after appliance removal (T 3 ). Generalized mixed models were fitted to assess the effect of the Haas-type expander compared to previously collected data (a nontreated and a Hyrax-type expander-treated group)., Results: RPE with Haas-type appliances had a negative impact on overall OHRQOL at T 1 and T 2 (P = 0.001), and a positive impact at T 3 (P = 0.001). The Haas-type expander had a significantly greater negative impact on OHRQOL than the Hyrax-type appliance during RPE. At T 1 , overall scores using the Haas-type expander were 1.08 times the scores using the Hyrax-type expander (i.e., 8% increase; 95% CI, 1.01-1.17; P = 0.033). Patients using the Haas appliance had 1.24 times the scores of those using Hyrax-type devices for the oral symptoms domain at T 1 (i.e., 24% increase; 95% CI, 1.06-1.46; P = 0.009)., Conclusions: Correction of the transverse maxillary deficiency by RPE using the Haas appliance in children 8-10 years improves OHRQOL. The Haas- and Hyrax-type devices temporarily worsen OHRQOL during treatment, however, the negative impact is less with the Hyrax-type expander than with the Haas-type expander, because it causes fewer negative oral symptoms., Clinical Relevance: From a patient-centered perspective, the use of the Hyrax over the Haas appliance may be suggested as it causes less negative oral symptoms during use., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Occlusal stabilization splints are the most common treatment for controlling the deleterious effects of sleep bruxism. This study aimed to evaluate the effectiveness of a low-cost, mixed occlusal splint (MOS) compared to that of a rigid splint. A randomized clinical trial was performed on 43 adults of both sexes with possible sleep bruxism and satisfactory dental conditions. They were divided into rigid occlusal splint (ROS) (n = 23) and MOS (n = 20) groups. Masticatory muscle and temporomandibular joint (TMJ) pain intensity (visual analog scale), quality of life (WHOQOL-BREF), indentations in the oral mucosa, anxiety, and depression (HADS), number of days of splint use, and splint wear were evaluated. All variables were evaluated at baseline (T0), 6 months (T6), and 12 months (T12) after splint installation (T0), and splint wear was evaluated at T6 and T12. Student's t-test, Mann-Whitney U test, non-parametric Friedman's analysis of variance for paired samples and pairwise multiple comparisons, Pearson's chi-square test, two-proportion z-test, non-parametric McNemar's and Cochran's Q, and Wilcoxon tests were used (p < 0.05). In both groups, there was a decrease in TMJ pain and pain intensity over time and improvements in the quality of life scores. At T6, there was a higher rate of splint wear in the MOS group than in the ROS group (p = 0.023). The MOS showed a higher rate of wear than the rigid splint but had similar results for the other variables. Therefore, the use of a mixed splint appears to be effective in controlling the signs and symptoms of sleep bruxism.

Background: This study explored the layperson's perception of comfort, satisfaction, and willingness to use various accessories in clear aligner therapy., Methods: A total of 267 people analyzed standardized intraoral photographs of a female model in orthodontic treatment using: 1) only clear aligner (CA), the control group; 2) clear aligner+attachments (AT); 3) clear aligners+Cl II elastics (EL); 4) clear aligner+hybrid treatment with esthetic braces (HEB); 5) Clear aligner+hybrid treatment with metallic braces (HMB); 6) clear aligner+mini-implants (MI); 7) clear aligner+mini-implants and elastics for intrusion (MIE). In addition, a social media questionnaire was distributed to assess the willingness to undergo orthodontic treatment with various accessories., Results: There was a significant difference between CA and all the other groups ( P <0.001), with CA being considered more comfortable and providing greater satisfaction compared to other accessories. Moreover, AT showed a significant difference in reducing treatment time compared to other groups., Conclusion: The CA was the most comfortable, exhibiting a higher satisfaction rate and a greater willingness to use it. The AT therapy was perceived as more comfortable and was associated with higher satisfaction and a greater likelihood of use, especially if it resulted in reduced treatment time. On the other hand, the participants reported that the HMB, MI, and MIE accessories were less comfortable., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (©2024 The Author(s).)

Objectives: This study assessed laypeople's perceptions of orthodontist credibility based on malocclusions and whether these views affect their choice to seek treatment. Eye-tracking technology and questionnaires were utilized., Materials and Methods: Ninety-five lay raters, through eye tracking and a questionnaire, assessed 12 images of orthodontists with malocclusions. Malocclusions were categorized by the Index Of Treatment Need (IOTN) as grade 1 (near ideal), 3 (anterior crowding), and 5 (with diastemas). Fixation points were recorded, and credibility was gauged via questionnaires. A Mentimeter word cloud was generated., Results: IOTN 1 orthodontists were viewed as more credible than IOTN 3 (p < 0.001) and 5 (p < 0.001). Raters were more willing to receive treatment from IOTN 1 orthodontists. The focus for IOTN 1 was between eyes and mouth, while IOTN 3 and 5 were on the mouth. "Crooked teeth" and "spacing" were predominant in word clouds for IOTN 3 and 5., Conclusion: Orthodontists with an IOTN grade 1 rating were perceived as more competent, reliable, and professional, thus making it more likely for laypeople to choose them as their preferred providers., Clinical Relevance: The smiles of professionals play a significant role in laypeople's decision to choose them as their orthodontist, and strategic utilization of social media can effectively deliver health information to a larger audience in a faster and more direct manner., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Artificial Intelligence (AI) is a tool that is already part of our reality, and this is an opportunity to understand how it can be useful in interacting with patients and providing valuable information about orthodontics., Objective: This study evaluated the accuracy of ChatGPT in providing accurate and quality information to answer questions on Clear aligners, Temporary anchorage devices and Digital imaging in orthodontics., Methods: forty-five questions and answers were generated by the ChatGPT 4.0, and analyzed separately by five orthodontists. The evaluators independently rated the quality of information provided on a Likert scale, in which higher scores indicated greater quality of information (1 = very poor; 2 = poor; 3 = acceptable; 4 = good; 5 = very good). The Kruskal-Wallis H test (p< 0.05) and post-hoc pairwise comparisons with the Bonferroni correction were performed., Results: From the 225 evaluations of the five different evaluators, 11 (4.9%) were considered as very poor, 4 (1.8%) as poor, and 15 (6.7%) as acceptable. The majority were considered as good [34 (15,1%)] and very good [161 (71.6%)]. Regarding evaluators' scores, a slight agreement was perceived, with Fleiss's Kappa equal to 0.004., Conclusions: ChatGPT has proven effective in providing quality answers related to clear aligners, temporary anchorage devices, and digital imaging within the context of interest of orthodontics.

Background: Oral mucosa indentations can be signs of awake bruxism (AB) in adults, but this association has not yet been verified in adolescents., Objectives: To evaluate the frequency of AB in adolescents and determine whether there is an association between AB and oral mucosa indentation., Methods: This study enrolled 66 high school students, mean age of 16.9 (±0.54) years. Clinical inspection was performed to assess the presence or absence of tongue, cheek and lip mucosa indentation. AB was assessed by the Ecological Momentary Assessment method using the WhatsApp mobile app. Messages were sent 15 times a day, 7 days, between 8:00 AM and 7:00 PM at random times to choose one of the five oral behaviours: teeth contact, teeth clenching, teeth grinding, mandible bracing and relaxed jaw muscles. The non-parametric Mann-Whitney U-test for independent samples, Friedman test for paired samples, Friedman pairwise multiple comparisons non-parametric test, Pearson's chi-squared tests, and z-test of comparisons between two proportions were performed (p < .05)., Results: During the week the frequency of AB behaviours was 56.20%, teeth contact was the most frequent (37.68% ± 22.26%), significantly more frequent than other AB behaviours; there was a greater frequency of cheek indentation (27.27%) and no difference between genders in oral behaviours and indentations (p > .05). A higher frequency of AB behaviours was observed in individuals with a greater frequency of cheek indentation (p < .05)., Conclusions: Teeth contact and cheek indentation were the most frequent conditions among adolescents and AB behaviours are associated with this indentation., (© 2023 John Wiley & Sons Ltd.)

Objectives: This study aimed to identify predictors of perceived stress and quality of life (QoL) amongst dental master and doctoral students., Materials and Methods: This is a cross-sectional study with Brazilian students as participants (n = 707). The following instruments were administered: Perceived stress scale (PSS), the WHOQOL-BREF and a socio-demographic questionnaire. A linear regression model was estimated., Results: The results showed that female was associated with higher scores of PSS and lower scores of QoL. A negative correlation was observed between PSS and all four domains of QoL. Multivariate analysis revealed that the set of selected variables partially explained the variability of PSS score (28%) and the four QoL domains: physical (52%), psychological (62%), social relationships (25%) and environment (37%). The variable number of children, hours of sleep, concurrent work and study, leisure time and physical activity practice were associated with positive changes on QoL, whilst PSS and medication intake with negative. Lower PSS score was associated with the variables age, hours of sleep, leisure time and physical activity., Conclusions: Our findings suggest that perceived stress and medication intake due to study are important predictors of lower QoL in dental master and doctoral students, especially in the psychological domain. More hours of sleep, leisure time and physical activity improved both QoL and perceived stress scores and might be feasible coping strategies for these outcomes in this population., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This study aimed to evaluate the effects of chronic use of fluoxetine on the amount of orthodontic tooth movement and tissue changes in rats. A total of 192 Wistar rats were divided into 4 groups: S, 0.9% saline solution; F, 20 mg/kg of fluoxetine; SM, 0.9% saline solution with orthodontic movement; and FM, 20 mg/kg of fluoxetine with orthodontic movement. After 30 days of daily saline or fluoxetine administration, an orthodontic device (25cN) was used to mesially displace the first molar in animals of the groups SM and FM. The animals were euthanized 2, 7, 14, and 28 days after placement of the orthodontic appliances and animals of groups S and F were euthanized at the same time. The assessment of tooth movement was made in gypsum castings, the collagen neoformation was assessed by polarization microscopy, the number of osteoclasts and root resorption were evaluated using tartrate-resistant acid phosphatase, and presence of hyalinized areas was assessed by hematoxylin-eosin staining. Fluoxetine did not affect the amount of tooth displacement, percentage of collagen, number of osteoclasts, and presence of hyalinized areas (P>0.05). There was a higher frequency of root resorption areas in the FM group than in the SM group only on the second day (P<0.05). The findings of this study show that chronic use of 20 mg/kg fluoxetine does not affect the amount of tooth movement, collagen neoformation, number of osteoclasts, or hyalinized areas and does not affect root resorption until the last day of orthodontic movement.

Background: Facial aging is associated with the loss of soft tissue fullness. Perioral signs of facial aging can add years to individuals' appearances and even affect their facial expressions in smiling and nonsmiling images., Aims: To evaluate the influence of the nasolabial fold on the visual perception of esthetics and age in the elderly, eye-tracking and a visual analog scale were used., Material and Methods: This study applied a cross-sectional study using 40 laypeople. Facial images of an elderly woman were modified to include facial expression lines such as nasolabial folds and marionette lines with no folds, intermediate, and accentuated depths folds. Eye tracking was implemented to measure the average number of fixations. Heat maps and dot maps were generated using eye-tracking software. A visual analog scale of attractiveness and age perception questionnaire were also incorporated into the study. Statistical analysis was performed using a significance of ( P <0.05)., Results: The majority of visual attention was paid to the eye and mouth areas. In the images with no folds, the right eye attracted a greater degree of fixation. In the images in which nasolabial folds were accentuated, the mouth area served as an area of high fixation. No statistical difference was observed between the groups in which smiling images were viewed. Nonsmiling images demonstrated significant differences between groups for variables including time until first fixation, complete fixation time, and number of fixations on the eyes and hemifaces. Old age and diminished attractiveness were associated with attenuated nasolabial folds, especially in nonsmiling images., Conclusion: The facial lines and expressions of elderly female individuals were assessed by laypeople using eye-tracking, showing that the deeper one's nasolabial folds, the more aged and less attractive one appears, especially in nonsmiling images. Smiling pictures were perceived to be more attractive and youthful; these perceptions should be considered in the search for improved esthetic results, whether in dental or facial esthetic treatments., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Contemporary Clinical Dentistry.)

Background. This study aimed to evaluate the visual facial perception in response to scars associated with repaired cleft lip (CL) on a male adolescent patient, as assessed via eye-tracking. Methods. Index of orthodontic treatment need (IOTN) malocclusions, grades 1, 5, and 8 were added to the frontal view facial image of an adolescent male model showing asymmetries of the nose and upper lip after CL surgery using the software Photoshop CS5 ® software. The eye movements of 91 laypeople observers were tracked by an Eye Tribe infrared sensor connected to OGAMA © software. A Kruskal-Wallis test was used to identify differences in total fixation time and time until the first fixation for the areas of interest. A visual analog scale (VAS) of attractiveness was also used in the study. Statistical analysis was performed adopting a significance level of P <0.05. Results. The area of interest (AOI) were found to be the mouth and teeth, which were more focused on gazed at than any other area, regardless of the grade of IOTN. For observers of different ages, there were significant differences in the time until the first fixation on the scar of the repaired CL region for IOTN grade 1 ( P =0.007). Images showing IOTN grade 1 repaired CL regions received the highest VAS scores. The older the age, the greater the tendency to give a higher VAS score for the same malocclusion. Conclusion. The presence of a CL scar on the upper lip did not attract the eye of laypeople observers of different ages, regardless of the degree of malocclusion in the non-smile image. The age of the observers did influence the perception of attractiveness, with older observers giving higher scores than younger ones. As the severity of the malocclusion increased, they were found to be less attractive., (©2022 The Author(s).)

Purpose: The present study was designed to investigate the perception of unilateral cleft lip (UCL) repair scar using an image of an adolescent and eye-tracking technology., Material and Methods: Frontal and oblique views of an image of an adolescent with a unilateral upper lip scar result of a corrective surgery. Eighty-five laypeople respondents were divided into three groups: Group A (15-44 years of age); Group B (45-59 years of age); and Group C (≥ 60 years of age). Gaze tracking was carried out to assess the location on the image of greatest fixation, to create dot maps and to follow the trajectory of the gaze. Respondents also assessed six attention questionnaires. The answers and assessment of the VAS were compared. P-values &lt;0.05 were considered significant in the analyses., Results: The central focus of the visualization was concentrated on the upper lip and the region of the nostril, followed by the eyes. Time until 1st fixation upon right lip and mouth showed differences with regard to different images. Images of the model shown in various guises including smiling or not, in a frontal or oblique views showed significant differences in VAS scoring (p&lt;0.001)., Conclusion: The presence of a scar from the UCL repair in an adolescent was noted in the foreground by laypeople. The scar was associated with a lower degree of attractiveness, happiness, and intelligence, as well as with shyness and sympathy, although a visible scar did not influence the perception of "good hygiene habits"., (Copyright © 2022. Published by Elsevier Masson SAS.)

Introduction: This retrospective study aimed to evaluate whether the treatment of Class II malocclusion with Invisalign aligners with sequential distalization of posterior teeth in adult patients would meet the criteria of American Board of Orthodontics (ABO) standards for the treatment and assess the predictive value of ClinCheck Pro software with the final results comparing the initial time, predictive planning using ClinCheck Pro software, and the final time without any require refinement., Methods: The sample consisted of 32 adult patients with Class II malocclusion (n = 32 [7 men and 25 women]; mean age 35.47 ± 9.61 years). All of them used a set of Invisalign aligners; no refinement set was evaluated. The 7 measurements of the ABO Model Grading System, the millimeter measurements for the anteroposterior ratios of maxillary first molars and the overbite were used in the evaluations and were compared in phases initial time, predictive planning using ClinCheck Pro software, and the final time. For the intraexaminer reliability test, the intraclass correlation coefficient was calculated to analyze the reliability of the measures. The Shapiro-Wilk normality test was used to examine whether the variables were normally distributed. The Wilcoxon nonparametric test for paired samples was applied for variables that did not show normal distribution. The parametric Student t test for paired samples was used for variables that presented normal distribution. The significance level adopted for this study was 0.05., Results: In comparison between final ClinCheck and posttreatment results, the ABO index showed a statistically significant difference between the predictions and results for alignment and rotation, buccolingual inclination, overjet, occlusal contact, occlusal relationship, molar relationship, and overbite. The final score of the ABO scores did not meet the standards for Class II correction, contrary to what the ClinCheck Pro software predicted., Conclusions: The null hypothesis that distalization of the posterior teeth occurs in adult patients using Invisalign aligners was rejected. The treatment of Class II malocclusion with Invisalign aligners did not occur as estimated by the virtual planning prepared by ClinCheck according to the standards for evaluating occlusal results established by the ABO at the end of the use of a set of aligners with sequential distalization., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: This study aimed to investigate whether the alignment of the teeth while smiling alters the visual perception by laypeople using eye tracking., Methods: Facial images (two males and two females) were digitally edited to show a smile pattern with aligned teeth and one with crowded teeth. Sixty laypeople were selected to observe the images. The number of fixations, fixation duration, and time until the first fixation were recorded using an eye-tracking system. The results were qualitatively calculated with dot maps. Numerical data were analyzed using an independent Student's t test., Results: There were no significant differences in fixation duration and the number of fixations in the crowded smile, mainly that of the male. The fixation times for the teeth were significantly different when the participants viewed the male subjects with a crowded smile ( P <0.05). Dot maps showed greater attention to the smile with crowded teeth in both genders., Conclusion: The crowded maxillary incisor smile attracted more visual attention to males from laypeople., Competing Interests: The authors declare that they have no competing interests., (©2022 The Author(s).)

Introduction: This trial aimed to longitudinally evaluate the effect of the treatment of transverse maxillary deficiency using rapid palatal expansion (RPE) on self-perceived oral health-related quality of life (OHRQOL) in children., Methods: Eighty participants aged 8-10 years with transverse maxillary deficiency and bilateral posterior crossbite were randomly assigned to 2 groups (n = 40 each): a group treated with RPE using hyrax-type appliances and a nontreated control group. OHRQOL was assessed by using the Child Perceptions Questionnaire for 8-10-year-olds at 4 times: before RPE, during RPE (T 1 ), at the end of RPE (T 2 ), and 1 month after the appliance removal (T 3 ). Generalized mixed models were used for data analysis (α = 0.05)., Results: Both groups exhibited similar demographic characteristics and OHRQOL scores at baseline. All participants completed the study. RPE had a time-dependent effect on OHRQOL. At T 1 and T 2 , this therapy is expected to increase the overall OHRQOL scores by 1.17 times (ie, ∼17% increase; T 1 95% confidence interval [CI], 1.08-1.26; T 2 95% CI, 1.09-1.27; P = 0.001). In contrast, the overall OHRQOL scores at T 3 are expected to be 0.28 times the baseline scores (ie, ∼72% reduction; T 3 95% CI, 0.26-0.31; P = 0.001). All individual domains of the OHRQOL evidenced a positive impact of treatment at T 3 (P = 0.001). Only the oral symptoms and social well-being domains showed a significantly negative impact of the treatment at T 1 and T 2 ., Conclusions: Correction of the transverse maxillary deficiency by RPE in children aged 8-10 years improves OHRQOL. There is a temporary worsening of OHRQOL during the treatment of this condition using RPE., Registration: This trial was not registered., Protocol: The protocol was not published before trial commencement., Funding: This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil, Financing Code 001., (Copyright © 2021. Published by Elsevier Inc.)

The treatment for intrusive dislocation is a clinical challenge and must be started soon after the intrusion injury. The affected tooth or teeth must be extruded by using light forces. This case report of traumatic intrusion of permanent central incisors aims to describe and discuss the process of repositioning the teeth in the dental arch. After a domestic accident, a 10-year-2-month-old boy suffered 11-mm intrusion of the maxillary central incisors along with enamel-dentin fracture and subluxation of the maxillary lateral incisors. Treatment started 2 days after the incident with an orthodontic extrusion of the maxillary central incisors with a fixed edgewise standard appliance. Orthodontic arches were used, and the force vectors were directed to the desired locations for the repositioning of the teeth. The treatment for extrusion and stabilization of the maxillary central incisors lasted 5 months and 22 days. Orthodontic traction with a fixed appliance is an effective procedure for the extrusion of both permanent maxillary central incisors intruded after trauma. Correct diagnosis, a short period between the trauma and the beginning of treatment, and appropriate mechanics were determining factors for a successful treatment., (Copyright © 2021 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to evaluate the visual facial perception in response to scars associated with repaired cleft lip (CL) on a male adolescent model, as assessed by eye-tracking technology., Material and Methods: Unilateral and bilateral facial images of repaired CL on the upper lip and nasal asymmetry were added to an image of a male adolescent model, using Photoshop CS5 software. 40 laypeople eye movements were tracked by an infrared sensor of the Eye Tribe hardware in conjunction with OGAMA software. An analysis of variance was used to identify differences in total fixation time for the added areas of interest. A visual analog scale of attractiveness with a questionnaire were also incorporated into the study. Statistical analysis was performed using a significance level of P < 0.05., Results: Significant differences were noted between the image with no scar and the image featuring a unilateral scar for total fixation time associated with the right eye (p = 0.002) and right nose area (p = 0.003), in addition to the numbers of fixations for the right eye (p = 0.005) and right nose area (p = 0.007). Comparing the image with no scar with the image featuring a bilateral scar showed a significant difference only for the number of fixations on the right eye (p = 0.005). The heatmaps and fixation point maps for both the unilateral and bilateral scar images indicated increased fixation for the scar areas. For the image with no scar, increased fixation was captured for the right eye area. Pearson's correlation coefficient test showed a moderate positive (p = 0.692) relationship when comparing to unilateral and bilateral cleft scars., Conclusions: The participating laypeople perceived the cleft-repaired faces and did not perceive any difference in attractiveness between the images featuring the unilateral and bilateral postsurgical clefts and lip scarring., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Orthodontic Science.)

Background: The maxillary lateral incisor is one of the teeth most likely to suffer agenesis, resulting in spacing between the central incisor and the canine., Objective: To compare maxillary lateral incisor agenesis with space closure treatment versus non-treatment based on measurements of the self-perceived oral-health-related quality of life (OHRQoL) and self-esteem of the participants., Subjects and Methods: A total of 44 people, aged 17-49 years, with missing lateral incisors were randomly assigned to two groups (n = 22 in each)-a treated group in which the space was orthodontically closed (TG) and a control group that remained untreated (CG). Randomization was performed by a researcher who was not involved in the clinical part of the study. The outcomes were assessed using the Oral Health Impact Profile and Rosenberg's Self-Esteem Scale, which were applied before (phase 1) and after (phase 2) the orthodontic treatment in the TG, and at baseline (phase 1) and 12 months after (phase 2) in the CG. All the data were blindly evaluated, supporting the single-blinded design of the study., Results: All participants finished the randomized controlled trial, and the demographic characteristics were similar between the groups. In phase 1, the levels of self-esteem and OHRQoL at baseline were similar (P = 0.079, P = 0.693, respectively). In phase 2, the self-esteem scores of the CG decreased and the OHRQoL increased (P = 0.005, P < 0.001, respectively), while self-esteem increased in the TG and the OHRQoL decreased (P < 0.001). The CG had lower scores than the TG for self-esteem, but the opposite was observed for OHRQoL (P < 0.001)., Limitations: Information bias may have occurred. Since the questionnaires could not have been applied at the same time in both groups, the time difference between the two assessments may have led to random and systematic error., Conclusions: The spacing resulting from missing maxillary lateral incisors had a negative impact on the OHRQoL and self-esteem of the participants, while orthodontically closing those spaces had a positive impact on those aspects., Clinical Trial Registration: This study was not registered., Protocol: The protocol was not published before trial commencement., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: To study the influence of black space between the maxillary central incisors on the aesthetic visual perception of the face, via eye-tracking and visual analogue scale (VAS)., Methods: Black space between the central incisors was created, for both sexes, as follows: control, 1-mm black space, 2-mm black space and 3-mm black space. Ninety raters participated in this study, divided into three groups: 30 laypeople, 30 nonorthodontists, and 30 orthodontists. After the visual calibration of each observer, eight photographs were presented in the Ogama® software concomitant with the use of the hardware The Eye Tribe®. Ogama generated information depending on the eye-tracking of each rater, regarding the time until the first fixation, time of fixation, heatmap, scanpath, and total time of fixation, to evaluate the areas deemed to be of interest according to the raters. Later on, the VAS was used, where each rater evaluated the images in an album on a scale of zero to 10 points., Results: The eyes and mouth were the areas more often noticed by the raters according to the heatmaps, while no significant difference was observed in time until the first fixation between the three groups of raters (p> 0.05). However, regarding the time of fixation on the mouth, a significant difference was observed (p< 0.05) when comparing the three groups., Conclusion: Black space has a negative effect on the aesthetic perception of the face. The amount of attention on the mouth is correspondent to the size of the black space.

Background: Many patients choose health professionals using the Internet, whether through websites or social media. In orthodontics, an orthodontist's relationship with active and potential patients can be affected by social media interactions, both as a marketing tool and as a tool for providing educational information. The purpose of the present study was to analyze the public perception of professional credibility and willingness to become a client, based on images posted by orthodontists on Instagram., Method: This was a cross-sectional study performed using a digital self-administered questionnaire based on images from public Instagram profiles of orthodontists found using certain hashtags. The themes of the posts were analyzed through a qualitative analysis, and the results were expressed as categories. After analyzing 2445 images, 12 thematic categories emerged. A total of 446 individuals (225 laypeople, 66 dental students, and 155 dentists) evaluated the images in regard to the perception of professional credibility and willingness to become a client. One-way ANOVA and chi-square tests were applied, considering a 5% significance level., Results: It was found that more than 95% of the participants used social media, primarily Instagram, WhatsApp, and Facebook, and the social network most used to research health services was Instagram. Statistically significant differences were found in the mean value of perceived professional credibility between the groups (p < 0.05) for the following categories: "dental traction," "mini-implant mechanics," "before and after treatment," "aesthetic brackets," "metallic brackets," and "clear aligners." The categories "being a teacher" and "before and after treatment" had a higher impact on the participants' perception of credibility and willingness to become a client, unlike the "social relationship" and "family relationship" categories., Conclusions: Some of the themes found in the orthodontists' social media posts were found to influence the perceptions around professional credibility and willingness to become a client, although there were differences among the participants in the present study.

Introduction: This study was performed to evaluate the effect of isotretinoin on tooth displacement and tissues related to induced tooth movement (ITM) in rats., Methods: Wistar rats were randomly divided into 4 groups: vegetable oil (O; n = 40), 7.5 mg/kg isotretinoin (I; n = 40), vegetable oil + ITM (OM; n = 44), and 7.5 mg/kg isotretinoin and ITM (IM; n = 39). After the daily application of the solutions for 30 days, an orthodontic appliance was installed to mesially displace the maxillary first right molar (30 cN) of rats in the OM and IM groups. The animals were killed 2, 7, 14, or 21 days after placement of the devices. The animals in the O and I groups did not undergo ITM but were killed simultaneously. The animals were examined for tooth displacement, the neoformation of mature collagen, bone and root resorption, the presence of hyalinized areas, and trabecular bone modeling by microcomputed tomography., Results: There was no difference in tooth displacement, the number of osteoclasts, the presence of hyalinized areas, or trabecular bone among the O, I, OM, and IM groups across the periods tested (P >0.05). A lower percentage of mature collagen was found in the IM group than in the OM group on day 7 (P <0.05). A lower frequency of root resorption was found in the IM group than in the OM group on days 2 and 21 (P <0.05)., Conclusions: Isotretinoin at 7.5 mg/kg decreased root resorption in rats subjected to ITM., (Copyright © 2020. Published by Elsevier Inc.)

Objective: This study aimed to identify the predictors of perceived stress and quality of life (QoL) among graduate dental faculty., Methods: This cross-sectional study was conducted using a representative sample of 348 dental faculty members from master's and doctoral programs in Brazil. Data were collected using self-administered questionnaires between August and December 2018. QoL was assessed using the multidimensional World Health Organization Quality of Life assessment (WHOQOL-BREF). Perceived stress was assessed using the Perceived Stress Scale (PSS). Participant sociodemographic characteristics served as the independent variables. The data were subjected to linear regression analysis., Results: Women obtained higher PSS scores and lower QoL scores (P < 0.05). There was a negative correlation between perceived stress and all 4 QoL domains. Multivariate analysis revealed that a combination of the independent variables (i.e., sex, age, sleep duration, dual employment, medication intake due to work, and leisure time) explained 32% of the variance in perceived stress. Regarding QoL, perceived stress, sleep duration, and medication intake due to work explained 50%, 58%, 27%, and 40% of the variance in the physical health, psychological, social relationships, and environment domain scores, respectively. Sex (i.e., female) and medication intake due to work predicted higher levels of perceived stress. In contrast, age, sleep duration, dual employment, and leisure time were associated with lower levels of perceived stress., Conclusion: Perceived stress and medication intake due to work had a negative effect on QoL, whereas sleep duration had a positive impact on QoL., (© 2020 American Dental Education Association.)

Introduction: The objective of this study was to evaluate the distalization rate and changes in inclination of the maxillary canines in alveoli preserved with leukocyte-platelet-rich fibrin (L-PRF) membranes in adult patients. The null hypothesis was that there are no differences in the canine distalization movement rate between the treated and the control sides., Methods: A total of 21 healthy adult patients with a minimum age of 20 years (mean age, 33 ± 5.9 years) and Angle Class I or Class II Division 1 malocclusion, who had an indication of extraction of the maxillary first premolars and orthodontic distalization of the maxillary canines were included in this study. A randomized controlled clinical split-mouth trial was conducted; the experimental maxillary side was treated with L-PRF membranes, and the other side served as the control. A randomization sequence of the experimental sides among patients was generated using the random number generation function of Microsoft Excel. Neither the patients nor the operators were blinded. Fifteen days after the extractions, distalization was initiated using an elastic chain applying 150 g of force to the canines on a 0.020-in stainless steel archwire. The distalization rate was the main outcome of the study, and it was assessed monthly for 5 months through the intraoral use of a flexible ruler. The degree of inclination of the canines was the secondary outcome, and it was evaluated through cone-beam computed tomography. A Shapiro-Wilk test was performed, and a Wilcoxon signed rank test was subsequently used to compare the experimental and the control group. Spearman rank correlation coefficient was calculated to evaluate the correlation between distalization and inclination for each side., Results: Four of the subjects dropped out of the study, leaving a total of 17 patients (n = 17). The distalization rate and inclination of the canines were greater on the control side than on the side treated with L-PRF (P <0.05). A weak correlation was found between the distalization rate and inclination of the canines for both sides (control side, ρ = 0.17; experimental, ρ = 0.11). No harm was observed during the study., Conclusions: The null hypothesis was rejected. The use of L-PRF in young adult patients decreased the rate of distalization and changes in inclination of the maxillary canines compared with the control group., Registration: This trial was not registered., Protocol: The protocol was not published before trial commencement., (Copyright © 2020 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the perception of esthetics and the attractiveness of the smile, in frontal view, with mandibular asymmetry, through the eye-tracking., Materials and Methods: OGAMA software and The Eye Tribe Tracker hardware were used to obtain eye tracking in certain areas of interest on the face. To simulate asymmetry, Photoshop® image editing software was used to create a vertical reference line to the midline of the face and make it symmetrical with control of the angulation relative to another horizontal reference line passing through the vertices. Then, the lower third of the face added asymmetries or deviations, starting from zero, with increments of 2 by 2 degrees up to 6 degrees. The study included 60 laypeople, 30 males and 30 females, without any knowledge about the study, showing good vision, and not having used drugs with the possibility of influencing cognitive or motor skills., Results: From the heat map in cases of mandibular asymmetry, it is possible to visualize that for both sexes the evaluators evaluated with a certain degree of similarity mainly when the deviations presented with 6 degrees. The trajectory of the male and female gaze in cases with asymmetry shows that in cases with a magnitude of 6 degrees, the raters traced mainly in the region of the mouth with little transition in the eye region and mainly in the areas of interest considered as "other." In the images presented with a magnitude of up to 4 degrees, they were traced in the general image., Conclusions: The perception of laypeople from mandibular asymmetry to the right in females presented a higher perception when compared to males with mandible asymmetry to the left., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Orthodontic Science.)

The objective of this study was to verify differences in eye-tracking metrics and subjective smile esthetic ratings between general practitioners, orthodontists, and laypersons in cases of maxillary lateral incisor gingival margin deviations. Unilateral apical and incisal gingival margin deviations of 1, 2, and 3 mm were digitally produced in pictures of a man and a woman smiling. Specific areas of interest (AOIs) were created in each picture. Eye-tracking metric data included the time to first fixation (TFF) and number of fixations (NF). A specific sensor and software were used to acquire information on the eye movements. Data on the smile esthetic ratings were obtained using a visual analog scale (VAS). Analysis of variance and Pearson correlation were applied. The TFF on the AOIs in the mouth was shorter for general practitioners and orthodontists, signifying that general practitioners and orthodontists rapidly perceived the features in these areas, while for laypersons, the TFF was shorter for the AOIs of the eyes (P < .05). The NF was greater on the AOIs in the mouth for general practitioners and orthodontists, whereas to the laypersons, the NF tended to be greater on the AOIs in the eyes. Mean VAS scores differed between observer groups (P < .05). For the male picture, the 1-mm and 2-mm apical gingival margin deviations received the highest scores from the laypersons, while for both female and male pictures, the 1-mm apical deviation received the highest scores from the general practitioners and orthodontists. Higher VAS scores resulted in longer times that general practitioners and orthodontists spent looking at the gingival margin changes. General practitioners and orthodontists differ from laypersons in their perceptions of smile esthetics. Eye-tracking metrics revealed that the AOIs in the mouth aroused greater interest from the general practitioners and orthodontists, and this interest became greater as the gingival margin deviations increased to 3 mm. Laypersons fixated more on the AOIs of the eyes. The VAS scores indicated that general practitioners and orthodontists were more critical than laypersons, accepting smaller deviations in the gingival margins of the maxillary lateral incisors.

Anterior open bite malocclusion is generally associated with several causes. This case report describes the 2-phase treatment of a 13-year-old boy with a Class III malocclusion, severe anterior open bite, and bilateral posterior crossbite treated without surgical intervention. An orthopedic approach was performed in phase 1 with a hyrax-type palatal expander, followed by maxillary protraction with a facemask for a 10-month period to promote the correction of transverse and sagittal deviations. In phase 2, a comprehensive orthodontic approach using fixed preadjusted appliances associated with intermaxillary elastics was performed. These approaches, combined with good patient compliance, established a functional and esthetic occlusal relationship, normal overjet and overbite, and a well-balanced facial appearance. The 4.5-year follow-up indicated that treatment results were stable., (Copyright © 2019 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: An adolescent girl, aged 12 years 11 months, was evaluated for orthodontic treatment. Her chief complaints included a difficulty with keeping her lips passively closed and excessive gingival exposure upon smiling. Her treatment plan included (1) restriction of maxillary growth with cervical headgear, (2) extraction of the maxillary first premolars to reduce the maxillary protrusion and the mandibular second premolars to facilitate Class II dental correction, and (3) management of maxillary incisor intrusion via anchoring with mini-implants. When indicated, even in the absence of large space discrepancies, extractions can be beneficial to the patient. The final results showed an attractive smile, passive lip seal, and a more esthetic and balanced facial profile. Retention records confirmed the stability of the treatment. The 5-year follow-up visit revealed that the treatment results were quite stable., (Copyright © 2019 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)