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Background&objectives: Mechanical forces applied during an orthodontic tooth movement (OTM) propel several biochemical and molecular responses in the periodontal ligament and alveolar bone. Here, we compile the existing clinical and preclinical evidence on these biological changes, aiming to provide a comprehensive discussion on the influence of the mechanical parameters of the OTM in the biological profile of the periodontium. Material and methods: This systematic integrative review was conducted according to PICOS strategy and PRISMA guidelines. A bibliographic search was performed in three electronic databases (PubMed, Scopus, and Web of Science) to find research articles published until 2023 and written in English. This search resulted in a total of 2279 publications, which were independently assessed by two evaluators using appropriate tools. Results: Forty-six studies were selected for this review. These revealed that compression, and stretching of the periodontal ligament fibers and cells are observed in the initial phase of the OTM. Specifically, on the tension side, high levels of IL-1β, OPG, and TIMPs are identified. On the compression side, an increase of RANKL, RANK, and MMPs levels predominate. Conclusion: This paper describes the release profile of common biomarkers according to the orthodontic protocol, suggesting the most appropriate parameters to keep the teeth and their supporting structures healthy. Overall, this manuscript provides a better understanding of the OTM-associated biological phenomena, also highlighting the importance of early evaluation of oral health, and thus it contributes as a fundamental basis for the development of more effective and safe orthodontic treatments with conventional appliances and aligners.

Controlling root movement is one of the greatest challenges in orthodontic treatment with aligners, like Invisalign® aligners. Cone Beam Computed Tomography (CBCT) integration into ClinCheck®, enabling bone and root visualisation, allows a more accurate follow-up of the teeth position. This study aims to compare torque measurements of the upper central incisors with and without CBCT and relate them to the upper incisor inclination and facial biotype. In a sample of 70 teeth, torque measurements were obtained by importing images into AutoCAD® software (version 2024). The angle between the tooth’s long axis with CBCT duplicate and the tooth’s long axis without CBCT was obtained to assess the difference. Statistically significant differences between torque measurements with and without CBCT were found, as well as between these measurements and the inclination of the upper incisors. No statistically significant differences were found among the facial biotypes. The average values of 27.8° ± 3.4° and 21.5° ± 3.2° were obtained for the angle between the axes. Torque without CBCT was lower than torque with CBCT, for the same tooth. The angle between the axes had a similar mean for both teeth. CBCT integration into ClinCheck® allows for a more correct torque measurement.

This systematic review aims to assess the impact of high (>30 Hz) and low (≤30 Hz) frequency vibrations on orthodontic tooth movement (OTM). Several articles were collected through a systematic search in the databases MEDLINE and SCOPUS, following PRISMA methodology and using a PICO question. Relevant information on selected articles was extracted, and the quality of each study was assessed by the quality assessment tools EPHPP, ROBINS-1 and STAIR. Out of 350 articles, 30 were chosen. Low-frequency vibrations did not seem to accelerate OTM with aligners or fixed appliances, despite some positive outcomes in certain studies. Conversely, high-frequency vibrations were linked to increased aligner change, tooth movement, and space closure with fixed appliances. In vivo studies reported favourable results with high-frequency vibrations (60 Hz to 120 Hz), which stimulate bone biomarkers, facilitating alveolar bone remodelling. The results suggest that high-frequency vibration effectively speeds up orthodontic tooth movement, showing promise in both in vivo and clinical studies. Larger-scale research is needed to strengthen its potential in orthodontics.

Cardiac magnetic resonance (CMR) is an established tool for risk stratification in several cardiomyopathies, and its role in muscular dystrophies (MuD) looks promising. We sought to assess how CMR performs in predicting cardiac events in a real cohort of MuD patients. A prospective single-center study with the enrollment of consecutive adult MuD patients referred to cardiac screening from 2012 to 2018 with the collection of clinical and CMR data. During follow-up (FUP), major adverse cardiac events were considered a composite of device implantation, ventricular tachycardia (VT), hospitalization due to heart failure, and death. Sixty-five patients were included (mean age of 32±16, 51% female); the majority had myotonic dystrophy (34; 52.3%); most were asymptomatic (60; 92.3%) and at sinus rhythm (64; 98.5%). CMR was abnormal in 23 (43.3%) patients: left ventricle ejection fraction (LVEF)

Introduction. In orthodontics, patients’ esthetic expectations involve the final esthetic result as well as the treatment’s appliance choice. Personality traits can influence patients’ perception, treatment modality selection, expectations, compliance, and satisfaction with the treatment outcome, although there are very few studies on this interconnection between personality and orthodontic appliances. Objective. The aim of this study is to evaluate the relationship between personality traits and the esthetic perception of different orthodontic appliances. Materials and Methods. The online questionnaire is composed of three parts: (1) sociodemographic variables; (2) questions on the esthetic perception of different orthodontic appliances; (3) general personality assessment via the NEO-FFI. A total of 461 questionnaires were accepted. Results. There were statistically significant differences between laypeople and professionals related to assessing smiles and the need for orthodontic treatment. Laypeople identified a statistically significant relationship between personality traits and orthodontic appliances, in which esthetic perception is associated with high traits of agreeableness and openness. Neuroticism is most associated with orthodontic treatment with fixed appliances, which are the most conventional. Conclusions. Professionals tend to have a more critical judgment than laypeople as far as esthetics is concerned. Personality traits play an important role in esthetic perception and may influence orthodontic treatment.

Scissor bite does not correct spontaneously. It gradually worsens by overeruption, negatively affecting masticatory function. It is intended with this manuscript to evaluate the different treatment strategies to correct this malocclusion in adult patients, exploring treatment with clear aligners, bite ramps, and MS (miniscrews), especially in this case of a patient with unilateral right scissor bite, with high dental compensation in the three planes of space, asymmetrical sagittal dental position, overeruption on the scissor bite condition, and a high mandibular arch constriction and maxillary expansion. A comprehensive literature research was performed from 2002 until March 2023. PubMed and BVS databases were used, with the following keywords: “scissor bite OR brodie bite” AND “malocclusion” AND “treatment OR correction OR therapeutics”. Since correcting skeletal asymmetries after the growth completion is challenging, adult patient cases often involve a combined orthodontic-surgical approach. In the present clinical case, the severe limitations to decompensating tooth positions for a surgical treatment, with the necessity to perform lower asymmetric extraction and a must longer orthodontic treatment, were the major reasons to avoid the surgical approach, after the scissor bite correction. In spite of this, the efficiency of the clear aligners and auxiliaries like bite ramps, MS, and elastics in successfully correcting a complex scissor bite in an adult patient was demonstrated, with significant esthetic and functional commitment, demonstrated by the case reliability PAR (peer assessment rating) index.

The current systematic review appraises the effectiveness of the types of tooth movements performed with Invisalign® clear aligner on the maxillary incisors. An electronic literature search of published trials was performed through PubMed, LILACS, Scopus, Cochrane Library, and Web of Science databases, and selected journals, from 2009 to 2020. Out of 291 references, five relevant publications were identified for analysis: four studies were performed retrospectively and one prospectively, all non-randomized. Despite the limited set of selected articles, the sample size is significant, with 148 subjects included in the reviewed studies involving the orthodontic treatment of upper incisors. We concluded that movements with the Invisalign® clear aligner on the upper incisors present distinct accuracy, possibly related with movement complexity; intrusion of the incisors has low accuracy (in some cases, 0% of accuracy was reported when the tooth extruded), while incisor extrusion exhibit some of the highest accuracy values reported in the included studies (45%-142%, when the achieved movement was greater than the predicted). Besides, axial (i.e., torque and tip) and horizontal (i.e., translation and rotation) movements are usually effective, with accuracy values between 39%-156% and 42%-79%, respectively. Overall, we determined that the efficiency of aligner to reach the desired movements in the upper incisors was low, as often refinements were required in the included studies. The use of aligner features must be more often considered to improve movement accuracy.

Primary headache disorders (PHD), specifically migraine, are strongly associated with temporomandibular disorders (TMD), sharing some patterns of orofacial pain. Both disorders have significant genetic contributions already studied. PRISMA guidelines were followed to conduct this systematic review, which comprehensively summarize and discuss the genetic overlap between TMD and PHD to aid future research in potential therapy targets. This review included eight original articles published between 2015 and 2020, written in English and related to either TMD and/or PHD. The genes simultaneously assessed in PHD and TMD studies were COMT, MTHFR, and ESR1. COMT was proved to play a critical role in TMD pathogenesis, as all studies have concluded about its impact on the occurrence of the disease, although no association with PHD was found. No proof on the impact of MTHFR gene regulation on either TMD or PHD was found. The most robust results are concerning the ESR1 gene, which is present in the genetic profile of both clinical conditions. This novel systematic review highlights not only the need for a clear understanding of the role of ESR1 and COMT genes in pain pathogenesis, but it also evaluates their potential as a promising therapeutic target to treat both pathologies.

Among the adjunctive procedures to accelerate orthodontic tooth movement (OTM), ultrasound (US) is a nonsurgical form of mechanical stimulus that has been explored as an alternative to the currently available treatments. This study aimed to clarify the role of US in OTM by exploring different stimulation parameters and their effects on the biological responses of cells involved in OTM. Human fetal osteoblasts and periodontal ligament fibroblasts cell lines were stimulated with US at 1.0 and 1.5 MHz central frequencies and power densities of 30 and 60 mW/cm2 in continuous mode for 5 and 10 min. Cellular proliferation, metabolic activity and protein expression were analyzed. The US parameters that significantly improved the metabolic activity were 1.0 MHz at 30 mW/cm2 for 5 min and 1.0 MHz at 60 mW/cm2 for 5 and 10 min for osteoblasts; and 1.0 MHz at 30 mW/cm2 for 5 min and 1.5 MHz at 60 mW/cm2 for 5 and 10 min for fibroblasts. By stimulating with these parameters, the expression of alkaline phosphatase was maintained, while osteoprotegerin synthesis was induced after three days of US stimulation. The US stimulation improved the biological activity of both osteoblasts and periodontal ligament fibroblasts, inducing their osteogenic differentiation.

Numerous pieces of evidence have supported the therapeutic potential of photobiomodulation (PBM) to modulate bone remodeling on mechanically stimulated teeth, proving PBM’s ability to be used as a coadjuvant treatment to accelerate orthodontic tooth movement (OTM). However, there are still uncertainty and discourse around the optimal PBM protocols, which hampers its optimal and consolidated clinical applicability. Given the differential expression and metabolic patterns exhibited in the tension and compression sides of orthodontically stressed teeth, it is plausible that different types of irradiation may be applied to each side of the teeth. In this sense, this study aimed to design and implement an optimization protocol to find the most appropriate PBM parameters to stimulate specific bone turnover processes. To this end, three levels of wavelength (655, 810 and 940 nm), two power densities (5 and 10 mW/cm2) and two regimens of single and multiple sessions within three consecutive days were tested. The biological response of osteoblasts and periodontal ligament (PDL) fibroblasts was addressed by monitoring the PBM’s impact on the cellular metabolic activity, as well as on key bone remodeling mediators, including alkaline phosphatase (ALP), osteoprotegerin (OPG) and receptor activator of nuclear factor κ-B ligand (RANK-L), each day. The results suggest that daily irradiation of 655 nm delivered at 10 mW/cm2, as well as 810 and 940 nm light at 5 mW/cm2, lead to an increase in ALP and OPG, potentiating bone formation. In addition, irradiation of 810 nm at 5 mW/cm2 delivered for two consecutive days and suspended by the third day promotes a downregulation of OPG expression and a slight non-significant increase in RANK-L expression, being suitable to stimulate bone resorption. Future studies in animal models may clarify the impact of PBM on bone formation and resorption mediators for longer periods and address the possibility of testing different stimulation periodicities. The present in vitro study offers valuable insights into the effectiveness of specific PBM protocols to promote osteogenic and osteoclastogenesis responses and therefore its potential to stimulate bone formation on the tension side and bone resorption on the compression side of orthodontically stressed teeth.

The Invisalign® system (SmartForce® G8) aims to guarantee aesthetics and provide good orthodontic treatment results. Dentoalveolar expansion is possible with clear aligners and can be used to correct dentoalveolar crossbite, resolve crowding or modify the arch shape. Despite the treatment’s effectiveness, there is still disagreement among professionals concerning its true clinical potential. This study aimed to analyze the effectiveness and predictability of coronal tooth expansion movement in permanent dentition in patients who had completed the first phase of treatment with Invisalign® orthodontic aligners. Materials and Methods: The tooth movement tables of 75 previously selected cases were analyzed in terms of dental-arch width and expansion efficiency, through the Invisalign® platform, considering the pre-treatment (T0), planned treatment (TP) and post-treatment models (T1) using ClinCheck Pro® 6.0 software. All patients were treated by an orthodontic specialist and Invisalign® Diamond Provider in a private practice (T.P.). Results: Difference between T1 and T0: for each maxillary and mandibular measurement, there was a statistically significant difference between pre- and post-aligner treatment values. The greatest amount of expansion occurred in both the upper and the lower premolars. Difference between TP and T1: for each maxillary measurement, statistically significant differences were verified for the molar and canine. At the mandibular level, statistically significant differences were only verified in the first molar. Conclusions: The Invisalign® clear aligners are effective for simultaneous intra-arch expansion in both jaws.

Introduction and objectives: The coronavirus SARS-CoV-2 (COVID-19) pandemic has been an unmatched challenge to global healthcare. Although the majority of patients admitted with acute coronary syndrome (ACS) may not be infected with COVID-19, the quarantine and public health emergency measures may have affected this particular high risk group. The objective of this study is to assess the impact of the early period of the COVID-19 pandemic on ACS admissions and clinical course in a tertiary care hospital in Portugal's most affected region. Methods: This retrospective, case-control study included patients admitted with a diagnosis of ACS during March and April 2020 (pandemic group) and in the same period in 2019 (control group). Clinical course and complications were also assessed. Results: During the pandemic, there were fewer ACS admissions but presentation was more severe, with a larger proportion of acute ST-elevation myocardial infarctions (54.9% vs. 38.8%, p=0.047), higher maximum troponin levels and greater prevalence of left ventricular systolic dysfunction at discharge (58.0% vs. 35.0%, p=0.01). In this population, although not statistically significant, it was observed a delay between the onset of symptoms and percutaneous coronary intervention, which may traduce a deferred search for urgent medical care during the pandemic. Conclusion: The lockdown phase of COVID-19 pandemic was associated with fewer and more severe ACS in a Tertiary Care Hospital in Portugal's most affected region by the pandemic. Resumo: Introdução e objetivos: A pandemia pela COVID-19 colocou os sistemas de saúde em todo o mundo sob uma exigência sem precedentes. Apesar de a maioria dos doentes admitidos por síndrome coronária aguda não estar infetada com COVID-19, as medidas de saúde pública instituídas poderão afetar este grupo de risco particularmente elevado. O objetivo deste estudo passa por avaliar o impacto que a fase inicial da pandemia COVID-19 teve na apresentação e evolução clínica de doentes admitidos por síndrome coronária aguda num hospital terciário numa das regiões de Portugal mais afetadas pela pandemia. Métodos: Este estudo retrospetivo de caso-controlo incluiu doentes admitidos com o diagnóstico de síndrome coronária aguda entre março e abril de 2020 (grupo pandémico) e no mesmo período em 2019 (grupo controlo). Foram recolhidos dados em relação à evolução clínica em regime de internamento e após a alta. Resultados: Durante o período de pandemia, verificou-se uma diminuição do número de admissões por síndrome coronária aguda bem como apresentações mais graves, registando-se uma maior proporção de enfartes agudos do miocárdio com supradesnivelamento do segmento ST (54,9% versus 38,8%, p=0,047), níveis máximos de troponina I mais elevados, e maior prevalência de disfunção sistólica do ventrículo esquerdo à data de alta (58,0% versus 35,0%, p=0,01). Apesar de não se ter atingido valores estatisticamente significativos, observou-se um aumento do intervalo de tempo entre o início de sintomas e a realização de intervenção coronária percutânea, o que poderá traduzir um atraso na procura de cuidados de saúde. Conclusão: A fase inicial da pandemia COVID-19 associou-se a um menor número e uma maior gravidade de admissões por síndrome coronária aguda num hospital terciário numa das regiões de Portugal mais afetadas pela pandemia.

ABSTRACT Background: Naming and lexical retrieval difficulties are common symptoms of aphasia. Naming abilities are usually evaluated by means of real objects or pictures or line drawings that are printed. Objective: The aim of this study was to investigate whether the ability to name objects among individuals with aphasia is influenced by the dimensions of the visual stimuli and to understand whether the order of presentation of the stimuli, number of years of education and length of time post-onset are involved in the success of naming. Methods: The naming abilities of healthy controls and patients with acute or chronic aphasia due to stroke were assessed through presentation of two sets of 24 stimuli consisting of real objects and color photographs of the same objects presented on a screen. The results obtained under these two conditions were compared by means of within-subject paired ANOVA, controlling for presentation order. Results: 40 patients (62.4 ± 17.3 years old; 70% females; mean education level of 8.5 ± 5.3 years; and 60% evaluated within the first eight days after stroke) and 50 controls that were age, gender and education-matched were included. Object naming was significantly better than naming color photographs among the patients (p = 0.001), but no differences were observed among the controls. Age, education, length of time post-onset and presentation sequence did not have any impact on naming performance. Conclusion: These results suggest that use of digital color photographs for naming objects in assessment of aphasia may be associated with lower naming performance, compared with use of real objects. This needs to be taken into account when different forms of stimuli are presented in sequential aphasia evaluations.

Coronal torque is one of the key factors in orthodontic treatment. An adequate torque value has an impact on aesthetics and soft tissue profile. The aim of this quantitative, comparative and observational longitudinal cohort study was to analyze the efficacy of the maxillary central incisor coronal torque in the Invisalign® system and evaluate the relation between coronal torque movement and patient’s facial biotype. In total, 27 patients were selected. The planned movements (TP) were obtained from the Invisalign Doctor Site® using mathematical formulas that consider the T0 measurements. Pre-treatment (T0) and after full use of the first set of aligners (T1) scanners were evaluated using Geomagic® Control X TM by superimposing T0 and T1 models using a transverse plane and the long axis of the tooth crown. IBM® SPSS® software was used for statistical purposes. We found statistically significant differences between T0 and T1 in pro-inclination and retro-inclination, as well as between achieved and planned values in pro-inclination (p = 0.011). We verified that hyperdivergent clinical cases presented higher mean values of coronal torque, and hypodivergent cases presented lower values. In pro-inclination, the differences between the planned and achieved values were greater in hypodivergent cases and smaller in hyperdivergent cases. In retro-inclination, the differences between the planned and achieved values were greater in normodivergent cases and smaller in hypodivergent cases. This study highlights that inefficacy is more accentuated in pro-inclination. Aligners are an effective tool for producing coronal repercussions of torque movement, being more effective in retro-inclination.

Bisphenol-A (BPA) is a xenoestrogen widely used as a synthetic precursor of resin monomers. There is arise need to acquire BPA-free resin-matrix composites to prevent the health effects of BPA. Six composites with distinctive manufacturer specifications were considered to evaluate the degree of release of BPA and bisphenol A-Diglycidyl Methacrylate (Bis-GMA) in a dental composite. The light-cured resin-matrix specimens (n = 5 for each composite type) were incubated at 37 °C in 1 mL of a 75% ethanol–water solution in a sealed amber glass vial for 7 days. The 75% ethanol–water solution was replaced daily and immediately frozen (−20 °C) until liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. BPA was not detected in any studied resin-based materials. However, Bis-GMA was detected in almost all the studied samples during the experiment, except AF and BF. The highest Bis-GMA concentration was released from ED at 67.43 ng/mL, followed by BE, FS, and NC with 40.75 ng/mL, 8.30 ng/mL, and 0.94 ng/mL, respectively. There is a clear need for more precise and standardized analytical methods to assess the short- and long-term release of resin-based materials. Furthermore, manufacturers should be obliged to provide complete details of the chemical composition of dental products and to promote the development of materials without estrogenic potential.

Treatment of unilateral or bilateral maxillary lateral incisor agenesis is challenging, time-consuming, expensive, and requires careful treatment planning, predictability, and esthetics. This review aimed to identify differences in esthetic perception among orthodontists, general dentists, differentiated dentists, and laypersons, which may interfere with treatment options. EBSCO, PubMed, ScienceDirect, Cochrane Library databases, and Google Scholar were searched using keyword pairing and a Boolean expression, “(congenitally missing OR agenesis OR hypodontia) AND (maxillary lateral incisors) AND (esthetic perception OR smile) AND (laypersons OR dental professional OR general dentist OR orthodontists).” Reviews and case studies were excluded. A total of 13 studies were selected for qualitative analysis (adapted ROBINS-I) and 11 were selected for meta-analysis (p < 0.05) after being sub-grouped into “Opening vs. Closure” and “No remodeling vs. Dental remodeling vs. Dental and gingival remodeling” groups. A meta-analysis evaluated the magnitude of the difference between groups based on differences in means and effect sizes (α = 0.05; 95% CI; Z-value 1.96), revealing that the esthetic perception of maxillary lateral incisor agenesis treatment remains controversial even among professionals. Gingival remodeling was not valued compared to isolated dental remodeling. Studies lack rigorously comparable methodologies. Discussion with the patient is pertinent in doubtful situations, as the best treatment option remains unclear, and overtreatment should be avoided.

Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. Material and Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.

Introduction. There is a growing demand for more aesthetic, comfortable, and faster orthodontic treatments, and clear aligners emerged as a solution to fulfill this need. However, the effectiveness of clear aligners to treat complex malocclusions is yet contentious. The use of acceleration methods could improve the efficacy of clear aligners by stimulating cells' mechanobiology through numerous pathways, but this hypothesis is still poorly explored. Objective. We aimed to monitor the release profile of an inflammatory marker-the interleukin-1β-and to evaluate its relationship with self-reported pain scores with and without the use of acceleration techniques during an orthodontic treatment requiring difficult tooth movements with clear aligners. Case Report. Here, we report a case of a 46-year-old female patient who presented functional and aesthetic complaints. Intraoral examination revealed a diminished overjet and overbite, rotation of teeth 45 and 24, absence of teeth 25, 35, and 36, buccolingual dislocation of tooth 21, a tendency to a Class III malocclusion, and a 2 mm left deviation of the lower midline. This study is divided into three stimulation phases: no stimulation, mechanical vibration stimulation, and photobiomodulation. Interleukin-1β levels in gingival crevicular fluid samples from the pressure side of six selected teeth were evaluated at four time points after the orthodontic treatment onset. Pain monitoring in those teeth was performed using a visual analogue scale at the same time points. Results. Interleukin-1β protein production peaked 24 h after treatment onset. Complex movements were associated with increased self-reported pain. Conclusion. Clear aligners show limitations in solving complex tooth movements, even when combined with acceleration. The development of customized and programmable stimulation microdevices integrated into “smart aligners,” which could be designed to specifically stimulate the direction of movement and stimulation parameters and could constitute a solution to optimize the orthodontic tooth movement with clear aligners.

Scissor bite (SB.) is a rare malocclusion that is challenging to diagnose and is often associated with a retrognathic mandible and a series of functional and structural abnormalities that negatively affect the patient. This article intends to analyze the treatment approaches applied to growing patients younger than 16 years old, comparing the conventional appliances described in the literature and a clinical case treated with clear aligners with mandibular advancement (MA.). SB is primarily related to skeletal Class I and II, according to Angle classification. In the various cases analyzed, it can also be mentioned as a significant number of cases with SB of dental origin (seven of dental and four of skeletal) in young patients. In children and adolescents who still have growth potential, the therapeutic possibilities are numerous. A comprehensive literature search was manually performed from 2002 until January 2023, in PubMed and BVS databases with the following conjugated keywords: “scissor bite OR brodie bite” AND “malocclusion” AND “treatment OR correction OR therapeutics”. The present case report on a young patient demonstrated the efficiency of the clear aligners with MA to correct an SB, associated with several functional and structural anomalies such as Class II division 1 with an increased overjet and overbite as well as a severe curve of Spee in a hypodivergent biotype.

The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol in the PubMed, Cochrane Library, LILACS, EBSCO, Scielo, between 2012 and 2022. The methodological quality was assessed by using the Newcastle–Ottawa Study Quality Assessment Scale. Mean differences and 95% confidence intervals were calculated and combined in meta-analyses. A total of 1202 participants were included in this systematic review (690 with TMD; 512 without TMD), with 22 articles being included in the qualitative analysis. Only three studies enabled the comparative analysis of the results. Ten articles showed a high methodological quality and a low risk of bias, and twelve had a low methodological quality and an increased risk of bias. The meta-analysis showed that the differences between the intervention and control groups were not statistically significant for the percentage overlapping coefficient of the anterior temporal muscle, for the masseter, and for the torque coefficient. The parameters analyzed with the compound technique for chewing showed altered mandibular functions in individuals with TMD. With the EMG method, it was possible to suggest that TMD in adult individuals causes compensatory muscle behaviors, and several changes in the masticatory function were found.

Introduction: Dilated cardiomyopathy (DCM) is a disease of the heart muscle characterized by ventricular dilatation and impaired systolic function. Familial forms account for 30-50% of cases. Autosomal dominant inheritance is the predominant pattern of transmission. Causal genetic variants have been identified in several genes and molecular diagnosis has implications for genetic counseling and risk stratification. Objective: We aimed to estimate the frequency of genetic variants and the molecular basis of DCM in Portugal. Methods: We performed a multicenter study of unrelated patients, recruited between 2013 and 2014. Variants in 15 genes were screened using PCR with direct sequencing (next-generation sequencing with at least 30-fold coverage combined with Sanger sequencing). Results: A total of 107 patients were included, 64 (60%) men, mean age at diagnosis 38±13 years, with 48 (45%) familial cases. In total, 31 rare variants in eight genes (mainly in MYBPC3, TNNT2 and LMNA) were identified, in 28 patients (26%). Only four variants had been previously described in association with DCM, 11 with hypertrophic cardiomyopathy, and nine variants were novel. Four variants were likely pathogenic and the remainder were of uncertain significance. We found no major differences in the main clinical and imaging characteristics between patients with or without rare variants and patients with likely pathogenic variants. Conclusions: Our results reflect the complexity and diversity of DCM genetics. For better interpretation of the pathogenicity of the variants found and their causative roles in DCM, molecular cascade screening of families is imperative. Further insight into genotype-phenotype correlations and risk stratification is desirable. Resumo: Introdução: A miocardiopatia dilatada (MCD) é uma doença do músculo cardíaco caracterizada por dilatação ventricular e compromisso da função sistólica. As formas familiares são responsáveis por 30 a 50% dos casos. O padrão de hereditariedade predominante é o autossómico dominante. Variantes genéticas causais foram identificadas em vários genes e o diagnóstico molecular tem implicações para o aconselhamento genético e estratificação de risco. Objetivo: Avaliar a base molecular da MCD em Portugal. Métodos: Estudo multicêntrico de doentes não relacionados, recrutados entre 2013 e 2014. Foram analisados 15 genes, através da técnica de PCR com sequenciação direta (NGS com pelo menos uma cobertura de 30 vezes combinada com sequenciação de Sanger). Resultados: Foram incluídos 107 pacientes, 64 (60%) homens, idade média ao diagnóstico de 38 ± 13 anos, com 48 (45%) casos familiares. Foram identificadas 31 variantes raras, em oito genes, (principalmente MYBPC3, TNNT2 e LMNA) em 28 pacientes (26%). Apenas quatro variantes tinham sido previamente descritas em associação com MCD, 11 com miocardiopatia hipertrófica e nove variantes eram novas. Quatro variantes foram classificadas como provavelmente patogénicas e as restantes de significado incerto. Não encontrámos diferenças significativas nas principais características clínicas e imagiológicas entre doentes com ou sem variantes raras e doentes com variantes provavelmente patogénicas. Conclusões: Estes resultados refletem a complexidade e diversidade genética da MCD. Para uma melhor interpretação da patogenicidade das variantes e potencial causalidade, o rastreio molecular das famílias é imperativo. Uma visão mais aprofundada das correlações genótipo-fenótipo e da estratificação de risco é desejável. Keywords: Dilated cardiomyopathy, Genetic variant, Next-generation sequencing, Palavras-chave: Miocardiopatia dilatada, Variante genética, Sequenciação massiva paralela

Introduction: The purpose of this article was to develop and validate a scale to assess common knowledge about temporomandibular disorders (TMDs) in the general population, evaluate the status of TMDs knowledge in the Portuguese population, quantify the severity and prevalence of TMDs-related symptoms in the general population, and assess the association between TMDs-related symptoms’ severity and demographic, medical and oral associated factors. Materials and Methods: This study was an analytical cross-sectional survey design. The sample consisted of 2165 participants selected through a snowball sampling method. The participants completed an online questionnaire regarding social and demographic characteristics, medical history, oral habits, Fonseca’s Anamnestic Index, a scale about difficulties on impulsiveness control and also the TMDs knowledge scale developed. The psychometric properties of the scale developed was tested on a small number of participants (n = 210). The P value set was 0.05. Results: Concerning psychometric properties all items showed a moderate-to-strong positive association with the loading factor. The Cronbach’s alpha was 0.956, showing good reliability. TMDs knowledge was positive in 1295 participants (59.8%). Multivariate-adjusted odds showed that female gender, diagnosis of tension-type headache, migraine, anxiety, impulsiveness, facial trauma, and parafunctional habits increased the risk of developing TMDs (adjusted odds ratios from 1.84 to 49.38). Conclusion: The scale developed is psychometrically valid and reliable and the participants had an overall positive knowledge about TMDs. A high prevalence of TMDs-related symptoms among the Portuguese population was found and the associated factors were female gender, impulsiveness, tension-type headache, migraine, anxiety, facial trauma, and parafunctional habits.

The increasing demand for more aesthetic/comfortable orthodontic alternatives fostered the utilization of clear aligners in recent years. However, the efficacy of clear aligners for treating complex malocclusions is often treated with scepticism. This case series aims to evaluate the predictability of the Invisalign® First system in moderate and severe cases requiring interceptive orthodontic treatments in mixed dentition. A total of 23 patients with 102 interceptive orthodontic malocclusion traits were selected for orthodontic treatment with Invisalign® First and were examined over 18 months (Phase 1). Clinical assessments included ClinCheck® predictions, cephalometric measurements, and measuring tools commonly used to quantify tooth movement. Measurements taken at the beginning and end of the treatment were compared. The complexity degree of each case was established based on the set of problems presented by each patient. All treatment objectives were achieved within 18 months, except for two Class II cases, with 69% of them solved with the first set of aligners. Additional aligners were used in the remaining cases. Even though these 23 cases suggest that the Invisalign® First (Phase 1) may be effective in most interceptive problems, controlled randomized clinical trials are required to evaluate movement predictability and how this relates to the problem complexity and additional aligners required.

Roasting is a key step for preparing sesame oil that leads to important changes in its organoleptic properties and quality. In this study, white sesame seeds were roasted for 20 min in an electric oven at different temperatures (120, 150, 180, 210, 250 and 300 °C). The oils extracted from unroasted and roasted seeds were compared for their chemical composition: fatty acids (including trans isomers), phytosterols, lignans (sesamin and sesamolin), tocopherols and total phenolic compounds, as well as their oxidative stability and antiradical capacity. There were no obvious differences in the oil densities, refractive indexes or iodine values, but the saponification values were affected by temperature. Relevant primary and secondary lipid oxidation were observed at T > 250 °C, resulting in a higher p-anisidine value and K232 as well as K268 values. Roasting improved oil yield (from 33.5 to 62.6%), increased its induction period (from 5.5 to 10.5 h) and enhanced the total phenolic content (from 152 to 194 mg/100 g) and antiradical activity of the extracted oil. Depending on roasting temperature, a gradual decline was recorded in total amounts of phytosterols (up to 17.4%), γ-tocopherol (up to 10.6%), sesamolin (maximum of 27.5%) and sesamin (maximum of 12.5%). All the investigated oils presented a low quantity in triglyceride polymers, clearly below the maximum tolerated quantity according to the European regulation. The optimal roasting temperature for obtaining high nutritional grade oil within the permissible values was 210 °C. The unsaponifiable components (including lignans and sterols) extracted from roasted seeds have been shown to be natural additives to fresh meatball products to extend shelf life. The results of this study may help to boost the nutritional content of plant-based diets by allowing for the use of roasted sesame seed oil and its components.

Aim: Our study aimed to test whether plasma acetylcholinesterase and butyrylcholinesterase enzyme activity were related to the presence and intensity of delirium in acute stroke patients. Methods: We carried out a matched (age and gender) case-control study, in a sample of consecutive patients with an acute infarct or intracerebral haemorrhage (≤7 days). We assessed delirium using the DSM-5 criteria and the Delirium Rating Scale, and we measured plasma acetylcholinesterase and butyrylcholinesterase enzyme activity after the patient's admission in the stroke unit and before hospital discharge. Mantel-Haenszel's chi-square was used to test bivariate associations between cases (delirious patients) and controls (non-delirious patients). Results: At admission in the stroke unit, cases and controls did not present significant differences in plasma acetylcholinesterase or butyrylcholinesterase activity. At hospital discharge (18 cases and 21 controls) patients who have had delirium at admission had higher levels of butyrylcholinesterase activity. Butyrylcholinesterase activity may secondarily increase due to the inflammatory process associated with neuronal dysfunction in delirium patients.

This study aimed to define the shelf life of canned sardines after opening to increase consumer awareness of their quality and safety and reduce food waste. For this purpose, canned sardines (Sardina pilchardus) packed with different sauces were opened and stored at 4 °C for 7 days. Microbiological, sensorial, physical and chemical stability was monitored daily by standard methodologies. Results show that the overall quality and safety are highly dependent on the sauce type. To preserve their full quality, sardines in brine and in vegetable oil should be consumed up to 1 day after opening, while sardines in tomato sauce were stable for up to 3 days, although none were considered nonedible up to the 7th day. Many parameters demonstrated statistical differences and correlations with storage, although they were not as decisive as sensory evaluation. This integrated approach should be adopted by the food industry and regulating authorities to provide information to consumers regarding the quality and safety of handled goods.

In Mozambique, rural communities produce flours from the dried pulp of Strychnos madagascariensis fruits. Owing to its high lipid content, the oil from this flour is frequently separated by pressing to be used as seasoning and medicine. Aiming to characterize this oil, flour samples (n = 24), dried at two different temperatures (55 °C and 65 °C), were collected from four local communities, together with a control sample prepared in the lab (50 °C). The resulting oil was fluid at room temperature, deep orange, and characterized by a high content of oleic acid (62–63%), followed by palmitic (20%) and linoleic (7%). It contained considerable amounts of tocols (25–34 mg/100 g) and carotenoids (8–10 mg/100 g), as well as sterols (431 ± 10 mg/100 g) and triterpenic alcohols (823 ± 4 mg/100 g mg/100 g). The overall composition was highly consistent between origins and temperatures, with only small statistically significant differences (p < 0.05), mostly between the community dried flours and control group. However, its high free fatty acid content (22–25%) reveals intensive enzymatic hydrolysis during the drying/fermentation steps, whose extension can be reduced by optimizing its technological process. Its chemical profile supports some of its folklore uses, revealing that it can be a promising source of edible oil, with health and technological potential that is worth optimizing and exploring.

Introduction and Objectives: Aortic dilatation can develop late after tetralogy of Fallot repair. Its extension beyond the aortic root is not clearly understood. We aimed to assess the prevalence and predictors of ascending aorta dilatation to set up an imaging protocol. Methods: In this prospective study including adult patients after tetralogy of Fallot repair followed at a referral center, we assessed the aorta by cardiovascular magnetic resonance and defined ascending aorta dilatation as an observed-to-expected ratio >1.5. Results: We included 78 adults (mean age 31±10 years; 56% female), with a mean follow-up of 23±7 years since tetralogy of Fallot repair. The prevalence of ascending aorta dilatation was 11.5%. The ascending aorta was larger than the sinuses of Valsalva in 12.8% of cases. Patients with ascending aorta dilatation were older, predominantly male, with later repair and larger left ventricular mass and volumes. By multivariate analysis left ventricular mass index (LVMI) was the only factor independently associated with ascending aorta dilatation (odds ratio 1.10, 95% confidence interval 1.01-1.20, p=0.03). A cut-off value of ≥57.9 g/m2 for LVMI had 89% sensitivity and 71% specificity for ascending aorta dilatation. Conclusions: Ascending aorta assessment as part of a routine cardiovascular magnetic resonance study after tetralogy of Fallot repair is recommended to screen for future aortic complications, particularly in males and older patients, and those with later repair and larger left ventricles. LVMI assessment has potential as a screening tool for ascending aorta dilatation with future clinical implications. Resumo: Introdução e objetivos: A dilatação da aorta é uma complicação tardia após correção da tetralogia de Fallot. A sua extensão além da raiz da aorta não está bem definida. Pretendemos avaliar a prevalência e os preditores de dilatação da aorta ascendente para elaborar um protocolo imagiológico. Métodos: Estudo prospetivo com adultos operados a tetralogia de Fallot seguidos num centro de referência. Estudamos a aorta por ressonância magnética cardiovascular e definimos dilatação da aorta ascendente pelo rácio observado-esperado > 1,5. Resultados: Incluímos 78 adultos (idade média 31 ± 10 anos; 56% mulheres); seguimento médio de 23 ± 7 anos desde a cirurgia. A prevalência de dilatação da aorta ascendente foi 11,5%. A aorta ascendente era maior do que os seios de Valsalva em 12,8% dos casos. Os doentes com dilatação da aorta ascendente eram mais velhos, maioritariamente homens, operados mais tarde, com massa e volumes ventriculares esquerdos maiores. Na análise multivariada a massa ventricular esquerda indexada foi a única variável independente associada a dilatação da aorta ascendente (odds ratio 1,10; intervalo de confiança de 95% 1,01-1,20; p = 0,03). A massa ventricular esquerda indexada ≥ 57,9 g/m2 apresentou uma sensibilidade de 89% e uma especificidade de 71% para dilatação da aorta ascendente. Conclusões: Recomendamos a inclusão da aorta ascendente na avaliação por ressonância magnética da tetralogia de Fallot operada, para prevenir complicações aórticas futuras, em particular em homens, doentes mais velhos, operados mais tarde e com ventrículos esquerdos maiores. A massa ventricular esquerda indexada tem potencial para ser usada no rastreio da dilatação da aorta ascendente com implicações clínicas futuras. Keywords: Aortic dilatation, Ascending aorta, Cardiovascular magnetic resonance, Tetralogy of Fallot, Palavras-chave: Dilatação da aorta, Aorta ascendente, Ressonância magnética cardiovascular, Tetralogia de Fallot

Introduction and Aims: Intrinsic aortopathy can lead to dilatation late after tetralogy of Fallot (TOF) repair. Its extent and prevalence are not known. We aimed to assess aortic dimensions and elasticity and to find predictors of aortic dilatation. Methods: A total of 126 adults were prospectively included after TOF repair and compared to 63 gender- and age-matched controls. Transthoracic echocardiography was used to assess aortic diameters at the level of the sinuses of Valsalva and ascending aorta and aortic dilatation was defined as z-score >+2. M-mode parameters of the ascending aorta were used to calculate strain, distensibility and stiffness index. Results: TOF patients (mean age 30±9 years; 52% male) had a complete repair at a median age of five (2-49) years; mean follow-up time since repair was 23±7 years. The prevalence of aortic dilatation at the sinuses of Valsalva and ascending aorta was 29% and 24%, respectively. Compared to controls, TOF patients had a higher ascending aorta z-score, lower strain (6.4% [0.0-61.5] vs. 15.2% [0.0-45.0], p +2. Parâmetros modo M da aorta ascendente foram usados para calcular strain, distensibilidade e índice de rigidez. Resultados: Doentes com tetralogia de Fallot (idade média 30 ± 9 anos; 52% homens) foram operados com uma idade mediana de 5 (2-49) anos; tempo médio de seguimento desde a cirurgia 23 ± 7 anos. A prevalência de dilatação dos seios de Valsalva e da aorta ascendente foi 29% e 24%, respetivamente. Comparado aos controlos, os doentes com tetralogia de Fallot apresentaram maior z-score da aorta ascendente, menor strain (6,4 [0,0-61,5] versus 15,2 [0,0-45,0]%; p < 0,01) e maior índice de rigidez (7,3 [0,8-23,6] versus 3,1 [0,9-14,1]; p < 0,01). Na análise multivariada o sexo masculino associou-se significativamente à dilatação dos seios de Valsalva (odds ratio 6,3, intervalo de confiança de 95% 1,5-26,3; p = 0,01). Conclusões: Na tetralogia de Fallot operada há uma prevalência significativa de dilatação tardia da aorta, com a aorta ascendente maior e mais rígida. O sexo masculino parece influenciar a dilatação da raiz da aorta. Esta aortopatia requer um seguimento cuidadoso para evitar complicações futuras. Keywords: Aortic dilatation, Aortic elasticity, Tetralogy of Fallot, Transthoracic echocardiography, Palavras-chave: Dilatação aórtica, Elasticidade aórtica, Tetralogia de Fallot, Ecocardiografia transtorácica

Objective: EEG value in possible transient ischemic attacks (TIA) is unknown. We aim to quantify focal slow wave activity (FSWA) and epileptiform activity (EA) frequency in possible TIA, and to analyse its contribution to the final diagnosis of seizures and/or definitive TIA. Methods: Prospective longitudinal study of possible TIA patients evaluated at a tertiary centre during 36 months and with 1–3 months follow-up. EEG was performed as soon as possible (early EEG) and one month later (late EEG). A stroke neurologist established final diagnosis after reassessing all clinical and diagnostic tests. Results: 80 patients underwent an early EEG (45.8 h after possible TIA): 52 had FSWA and 6 of them also EA. Early FSWA was associated with epileptic seizure or definitive TIA final diagnosis (p = .041). Patients with these diagnoses had more frequently early FSWA (19/23; 82.6%) than EA (6/23; 26.1%). 6/13 (46.2%) patients with epileptic seizure final diagnosis had EA.In the late EEG, 43 (58.1%) patients demonstrated persistent FSWA and 3 of them also EA. Persistent FSWA in the late EEG was more frequent in seizures than in TIA patients (91.7% vs. 45.5%). FSWA disappearance was associated with acute vascular lesion on neuroimage. Conclusions: FSWA was the commonest EEG abnormality found in the early EEG of patients with possible TIA, but did not distinguish between TIA and seizure patients. In patients with seizures, FSWA was more common than EA and its presence in the late EEG was more likely in patients with epileptic seizures than with TIA. Significance: The majority of possible TIA patients with the final diagnosis of epileptic seizures do not have EA in the early or late EEG. Keywords: Transient neurological symptoms, Transient ischaemic attack, Seizure diagnosis, Epilepsy, Epileptiform activity, Focal slow wave activity

The high proportions of monounsaturated fatty acids (MUFA) represent one of the most important technological and nutritional features of olive oils. The present study details the fatty acid (FA) composition of autochthonous cultivars (Lentisca, Madural, Redondal, Rebolã, Verdeal, and Verdeal Transmontana) produced from centenarian trees during five crop years (2013–2017). Olive cultivar highly influenced the FA composition, namely, oleic acid (70.3% for Madural to 80.7% for Redondal) and palmitic acid (10.4% for Lentisca to 13.5% for Verdeal). Similarly, crop year significantly influenced the individual FA contents. Principal component analysis of FA data enabled the unsupervised classification by cultivar and, within each cultivar, by crop year. Furthermore, the levels of nine individual FAs, together with the polyunsaturated fatty acid contents, selected using the simulated annealing algorithm, allowed for their correct classification, on the basis of linear discriminant analysis, according to the olive cultivar, with an overall sensitivity of 92%, for leave-one-out cross-validation procedure. Globally, the cultivar effect superimposed that of crop year, showing that some cultivars, such as Redondal and Verdeal Transmontana, have consistently high and homogeneous proportions of MUFA, indicating that they are worth exploring in terms of future selection of cultivars that are able to produce olive oils with increased nutritional value and that are less prone to oxidation.

Introduction: Cardiac remodeling is manifested as changes in size, shape and function of the heart. We studied the prevalence, prognosis and predictors of left ventricular reverse remodeling (LVRR) in idiopathic dilated cardiomyopathy (IDCM) after optimized medical therapy. Methods: A total of 113 IDCM patients were followed for 7.1±5.6 years. LVRR was defined as an increase of 10 units in ejection fraction (EF) and decrease in left ventricular diastolic diameter (LVDD), in the absence of resynchronization therapy. Results: Baseline EF was 27±8% and LVDD index was 37.1±6.3 mm/m2. LVRR occurred in 34.5% within 22.6 months. Final EF was 47.5±10.1%, LVDD index was 30.2±3.9 mm/m2. LVRR was associated with better NYHA class (I–II) and lower BNP (p

Oleaster (Olea europaea var. sylvestris), or the wild olive tree, has great interest as a source of genetic material for olive breeding programs. Nevertheless, information about its oil composition is scarce. In the present work, the characterization of oleaster fruit morphology and oil chemical composition from three different tree populations in Northeastern Portugal (Moncorvo, Alijó and Vila Nova de Foz Côa) was performed. The three studied populations presented some morphological differences in the fruits, but similar oil chemical composition. Oleic acid (68.9–70.6%) was the most abundant fatty acid. High variability was observed in total tocopherol content, ranging between 263 and 503 mg/kg. Additionally, high amounts of total sterols were found, from 1742 to 2198 mg/kg of oil. A rich composition in phenols was found with 14 phenolic compounds identified. The evaluated parameters for oleander oils allowed discriminating the oils according to the geographical origin and were consistent with those commonly found in olive oil, showing that they are particularly rich in antioxidants and can be exploited in breeding programs to increase the amounts of bioactive compounds in cultivated oils.