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INTRODUCTION: The vertical position of orthodontic brackets in maxillary incisors may influence the incisal step between the anterior teeth and thereby interfere with the smile esthetics. Even so, esthetic standards have been modified over time and consistently required technical adjustments. OBJECTIVE: This study analyzed orthodontists' preferences regarding the difference of bracket bonding height between the maxillary central incisors (MCI) and maxillary lateral incisors (MLI), and further determined whether the orthodontist sex, age and time of specialization have association to their choices. METHODS: This study collected data through an electronic form. Study participants analyzed a clinical case in which they indicated their preference for bracket bonding height. The placement height options ranged from 3.0 mm to 5.5 mm from the incisal edge, with 0.5-mm intervals, or at the clinical crown center (CCC). The difference in the bonding height between the MCI and MLI was analyzed, considering the formation of incisal steps between these teeth. RESULTS: Participants indicated that the difference in bracket bonding height between the MCI and MLI should be as follows: 0 mm (3.9%); 0.5 mm (78.3%); 1 mm (7.6%); 1.5 mm (0.2%); and CCC (9.9%). There was no statistically significant correlation between the choice for bracket bonding height and sex, age and time since specialization. CONCLUSION: Most participating orthodontists choose the 0.5-mm difference in bracket placement height between the MCI and MLI. The variables sex, age and time since specialization did not influence this choice.

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ABSTRACT Introduction: Invasive cervical resorption (ICR) is a relatively rare type of ERR (External Root Resorption), in which a localized resorption begins in the cervical area of the tooth, below the epithelial junction and above the ridge crest. Objective: Describe the clinical case of an 11-year-old boy with no dental trauma history, presenting moderate crowding and ectopic eruption of the maxillary right central incisor. He had been undergoing orthodontic treatment elsewhere, and his family was dissatisfied with the results. Description: A new treatment was indicated, which included rapid maxillary expansion followed by extraction of four premolars. During routine panoramic evaluation, a radiolucid image was detected and a periapical radiograph was requested. At this point, an ICR of the maxillary right central incisor was found. The treatment was cautiously finalized and despite the use of light forces, central incisor was severally compromised by ICR and was therefore extracted. Conclusion: This clinical example discusses the importance of routine radiographs for the early diagnoses of ICR.

RESUMO Introdução: A reabsorção cervical invasiva (RCI) é um tipo relativamente raro de reabsorção radicular externa (RRE), no qual uma reabsorção localizada começa na região cervical do dente, abaixo da junção epitelial e acima da crista marginal. Objetivo: Descrever o caso clínico de um menino com 11 anos de idade, sem histórico de trauma dentário, apresentando apinhamento moderado e erupção ectópica do incisivo central superior. Ele realizava tratamento ortodôntico em outro local, mas sua família estava insatisfeita com os resultados. Descrição: Foi iniciado um novo tratamento, que incluiu a expansão rápida da maxila, seguida pela extração de quatro pré-molares. Durante a avaliação de rotina da radiografia panorâmica, uma imagem radiolúcida foi detectada, e uma radiografia periapical da região foi solicitada, sendo encontrada uma RCI no incisivo central superior direito. O tratamento foi finalizado com cautela e, apesar do uso de forças leves, o incisivo central estava seriamente comprometido pela RCI e, portanto, precisou ser extraído. Conclusão: Esse exemplo clínico discute a importância das radiografias de rotina para o diagnóstico precoce da RCI.

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INTRODUCTION: Rapid maxillary expansion (RME) is assumed as a well established procedure; although, some effects on facial complex are not yet fully understood. OBJECTIVE: The aim of this research was to verify, using cone-beam computed tomography, the effect on linear dimensions of the nasal cavity. METHODS: Sample consisted of twenty patients aged 7 to 16 years, with skeletal deformity that justified the use of CT scans, and who required the RME as part of the orthodontic treatment planning. Scans were taken before clinical procedures were performed (T0) and after stabilizing the expander screw (T1). Dolphin Imaging v. 11.5 3D software was used to measure six areas on nasal cavity: three at the anterior portion (upper, middle, and lower) and other three at the posterior portion (also upper, middle, and lower). Data were statistically treated using Shapiro-Wilk test to verify normality. Differences between T0 and T1 were calculated using the Spearman correlation and paired Student's t-test, with a significance level of 5%. RESULTS: All linear measurements presented a significant increase (p< 0.05) after RME, both in the anterior and posterior regions, suggesting some parallelism on the opening pattern, especially at the lower portion (p< 0.001). CONCLUSIONS: RME was able to significantly modify the internal dimensions of the nasal cavity.

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ABSTRACT Introduction: Rapid maxillary expansion (RME) is assumed as a well established procedure; although, some effects on facial complex are not yet fully understood. Objective: The aim of this research was to verify, using cone-beam computed tomography, the effect on linear dimensions of the nasal cavity. Methods: Sample consisted of twenty patients aged 7 to 16 years, with skeletal deformity that justified the use of CT scans, and who required the RME as part of the orthodontic treatment planning. Scans were taken before clinical procedures were performed (T0) and after stabilizing the expander screw (T1). Dolphin Imaging v. 11.5 3D software was used to measure six areas on nasal cavity: three at the anterior portion (upper, middle, and lower) and other three at the posterior portion (also upper, middle, and lower). Data were statistically treated using Shapiro-Wilk test to verify normality. Differences between T0 and T1 were calculated using the Spearman correlation and paired Student's t-test, with a significance level of 5%. Results: All linear measurements presented a significant increase (p< 0.05) after RME, both in the anterior and posterior regions, suggesting some parallelism on the opening pattern, especially at the lower portion (p< 0.001). Conclusions: RME was able to significantly modify the internal dimensions of the nasal cavity.

RESUMO Introdução: A expansão rápida da maxila (ERM) é um procedimento bem estabelecido. Entretanto, alguns efeitos no complexo facial ainda não foram completamente compreendidos. Objetivo: O objetivo do presente estudo foi verificar o efeito da ERM nas medidas lineares da cavidade nasal, utilizando a tomografia computadorizada de feixe cônico (TCFC). Métodos: A amostra foi composta por 20 pacientes da Universidade Federal da Bahia, com idades entre 7 e 16 anos, com deformidades esqueléticas que justificavam o uso da TCFC e que necessitavam da ERM como parte do tratamento ortodôntico. As imagens tomográficas foram realizadas antes dos procedimentos clínicos (T0) e após estabilização do parafuso expansor (T1). O software Dolphin Imaging v. 11.5 3D (Dolphin, Chatsworth, CA, EUA) foi utilizado para mensurar seis áreas na cavidade nasal, três delas na região anterior (superior, média e inferior) e outras três na região posterior (também superior, média e inferior). Os dados foram trabalhados estatisticamente, utilizando o teste de Shapiro-Wilk para avaliar a normalidade. Diferenças entre T0 e T1 foram calculadas usando a Correlação de Spearman e o teste t de Student pareado, usando um nível de significância de 5%. Resultados: Todas as mensurações lineares apresentaram um aumento significativo (p< 0,05) após a ERM, tanto na região anterior quanto na posterior, sugerindo algum paralelismo no padrão de abertura, principalmente na porção inferior (p< 0,001). Conclusão: A ERM foi capaz de modificar significativamente as dimensões internas da cavidade nasal.

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OBJECTIVE: The objective of this study was to determine orthodontists', periodontists', and laypersons' perception of smile esthetics, regarding the presence of different levels of gingival recession on the maxillary left canine. MATERIAL AND METHODS: Two close-up smile images (frontal and oblique) of a white female were selected for this study. The images were digitally altered to create different levels of gingival recession on maxillary left canine, in 0.5-mm increments. They were randomly arranged into a photo album that was shown to 135 evaluators: 45 orthodontists, 45 periodontists, and 45 laypersons. Each evaluator was asked to rate the smile attractiveness, using to a visual analog scale. Data were analyzed statistically using ANOVA, Tukey's post-hoc test, and Student t-test. RESULTS: According to the orthodontists and periodontists, all levels of recession were considered as unesthetic in both types of images. According to the laypersons, gingival recession > 1.5 mm in the frontal image and > 1.0 mm in the oblique image were considered unesthetic. CONCLUSION: The results showed that the presence of unilateral gingival recession on maxillary canines may negatively influence smile attractiveness, depending on the evaluator type and the level of the recession.

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ABSTRACT Objective: The objective of this study was to determine orthodontists', periodontists', and laypersons' perception of smile esthetics, regarding the presence of different levels of gingival recession on the maxillary left canine. Material and Methods: Two close-up smile images (frontal and oblique) of a white female were selected for this study. The images were digitally altered to create different levels of gingival recession on maxillary left canine, in 0.5-mm increments. They were randomly arranged into a photo album that was shown to 135 evaluators: 45 orthodontists, 45 periodontists, and 45 laypersons. Each evaluator was asked to rate the smile attractiveness, using to a visual analog scale. Data were analyzed statistically using ANOVA, Tukey's post-hoc test, and Student t-test. Results: According to the orthodontists and periodontists, all levels of recession were considered as unesthetic in both types of images. According to the laypersons, gingival recession > 1.5 mm in the frontal image and > 1.0 mm in the oblique image were considered unesthetic. Conclusion: The results showed that the presence of unilateral gingival recession on maxillary canines may negatively influence smile attractiveness, depending on the evaluator type and the level of the recession.

RESUMO Objetivo: o objetivo do presente estudo foi determinar a percepção estética do sorriso, por ortodontistas, periodontistas e leigos, em relação à presença de recessão gengival no canino superior esquerdo. Métodos: foram selecionadas duas imagens aproximadas do sorriso (frontal e oblíqua) de uma mulher leucoderma. As imagens foram manipuladas para criar diferentes níveis de recessão gengival no canino superior esquerdo, em incrementos de 0,5 mm. Foram, então, distribuídas aleatoriamente em um álbum, que foi entregue a 135 avaliadores: 45 ortodontistas, 45 periodontistas e 45 leigos. Cada avaliador foi convidado a avaliar a atratividade das imagens em uma escala visual analógica. Os dados foram analisados estatisticamente pela ANOVA e pós-teste de Tukey e teste t de Student. Resultados: para ortodontistas e periodontistas, todos os níveis de recessão foram detectados como antiestético, em ambas as formas de visualização. Para os leigos, na vista frontal, a recessão gengival foi considerada antiestética a partir de 1,5 mm; enquanto na vista oblíqua, a partir de 1,0 mm. Conclusão: os resultados demonstraram que a presença de recessão gengival em caninos superiores pode impactar negativamente a atratividade do sorriso, dependendo do tipo de avaliador e da magnitude da recessão.

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INTRODUCTION: Invasive cervical resorption (ICR) is a relatively rare type of ERR (External Root Resorption), in which a localized resorption begins in the cervical area of the tooth, below the epithelial junction and above the ridge crest. OBJECTIVE: Describe the clinical case of an 11-year-old boy with no dental trauma history, presenting moderate crowding and ectopic eruption of the maxillary right central incisor. He had been undergoing orthodontic treatment elsewhere, and his family was dissatisfied with the results. DESCRIPTION: A new treatment was indicated, which included rapid maxillary expansion followed by extraction of four premolars. During routine panoramic evaluation, a radiolucid image was detected and a periapical radiograph was requested. At this point, an ICR of the maxillary right central incisor was found. The treatment was cautiously finalized and despite the use of light forces, central incisor was severally compromised by ICR and was therefore extracted. CONCLUSION: This clinical example discusses the importance of routine radiographs for the early diagnoses of ICR.

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INTRODUCTION: The aim of this study was to investigate whether there is any influence on the perception of smile esthetics among orthodontists and laypersons, with regard to different vertical positions of the maxillary central incisors. METHODS: Frontal smile photographs digitally altered at full-face view and close-up view of 2 adult men aged between 20 and 30 years were used. Six vertical positions of the central incisors were created, with changes of 0.5 mm. The images were randomly assembled in an album that was presented to 53 orthodontists and 53 laypersons, who evaluated the attractiveness of the images by using visual analog scales. Comparison among the images was performed using 1-way analysis of variance, with Tukey post-hoc test. To compare the distribution of the mean scores between the full-face and close-up smile views, and between orthodontists and laypersons, the Student t test was used. The level of significance was established at 5%. RESULTS: The best evaluations presented the following: (a) the gingival margins of the central incisors corresponded to, or were up to, 1 mm below the line of the canine gingival margins, and (b) the incisal step between the central and lateral incisors was from 1.0 to 2.0 mm. The smiles considered least attractive showed (a) the central incisor gingival margins were 1.0 mm above or 1.5 mm below the canine gingival margins, and (b) no step, or a step of 2.5 mm, between the central and lateral incisors. CONCLUSIONS: The results of this study suggested that, in men, slightly extruded central incisors were esthetically more attractive than intruded incisors.

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OBJECTIVE: The purpose of this study was to determine the perception of smile esthetics among orthodontists and laypersons with respect to unilateral maxillary canine torque variations in a frontal smile analysis. METHODS: Full face and close-up smile photographs of two subjects (1 man and 1 woman) were used. Both smiles displayed healthy maxillary anterior dentitions. The images were digitally altered to obtain a bilateral 0° torque in the maxillary canines. From this image, unilateral variations of the left canine were made with -15°, -10°, -5°, 0°, +5°, +10° and +15°. Final images were randomly assembled into an album that was given to 53 orthodontists and 53 laypersons. Each rater was asked to evaluate the attractiveness of the images using visual analog scales. Data collected were statistically analyzed with one-way analysis of variance with Tukey post-hoc test and the unpaired Student t test. RESULTS: For orthodontists, most attractive smiles were those with 0°, -5° and -10°. For laypersons, most attractive smiles were those with 0°, -5°, -10°, -15° and + 5°. For both groups, the lowest scores were given for the smiles with +10° and +15° torque. When comparing the perceptions of the orthodontists and laypersons, they did not show statistical differences in most situations. Moreover, in general, there was no significant difference between the full-face and close-up assessments of the smiles. CONCLUSIONS: The present findings indicated that smiles with unilateral palatal (negative values) maxillary canine torque variations were more tolerated than smiles with buccal crown torque (positive values) variations.

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ABSTRACT Objective: The purpose of this study was to determine the perception of smile esthetics among orthodontists and laypersons with respect to unilateral maxillary canine torque variations in a frontal smile analysis. Methods: Full face and close-up smile photographs of two subjects (1 man and 1 woman) were used. Both smiles displayed healthy maxillary anterior dentitions. The images were digitally altered to obtain a bilateral 0° torque in the maxillary canines. From this image, unilateral variations of the left canine were made with -15°, -10°, -5°, 0°, +5°, +10° and +15°. Final images were randomly assembled into an album that was given to 53 orthodontists and 53 laypersons. Each rater was asked to evaluate the attractiveness of the images using visual analog scales. Data collected were statistically analyzed with one-way analysis of variance with Tukey post-hoc test and the unpaired Student t test. Results: For orthodontists, most attractive smiles were those with 0°, -5° and -10°. For laypersons, most attractive smiles were those with 0°, -5°, -10°, -15° and + 5°. For both groups, the lowest scores were given for the smiles with +10° and +15° torque. When comparing the perceptions of the orthodontists and laypersons, they did not show statistical differences in most situations. Moreover, in general, there was no significant difference between the full-face and close-up assessments of the smiles. Conclusions: The present findings indicated that smiles with unilateral palatal (negative values) maxillary canine torque variations were more tolerated than smiles with buccal crown torque (positive values) variations.

RESUMO Objetivo: o objetivo do presente estudo foi avaliar a percepção estética do sorriso, por ortodontistas e leigos, em relação a variações unilaterais do torque do canino superior, em uma análise frontal do sorriso. Métodos: foram utilizadas fotografias de face total e de sorriso aproximado de dois indivíduos (1 homem e 1 mulher). Ambos os sorrisos exibiam dentição anterossuperior saudável. As imagens foram alteradas digitalmente para obtenção de um torque bilateral de 0° nos caninos superiores. A partir dessa imagem, variações unilaterais do canino esquerdo foram realizadas com -15°, -10°, -5°, 0°, +5°, +10° e +15°. As imagens finais foram montadas aleatoriamente em um álbum que foi entregue a 53 ortodontistas e 53 leigos. Cada avaliador foi orientado a avaliar a atratividade das imagens com escalas visuais analógicas. Os dados coletados foram analisados estatisticamente com análise de variância ANOVA com pós-teste de Tukey e teste t de Student não pareado. Resultados: para ortodontistas, os sorrisos mais atraentes foram aqueles com 0°, -5° e -10°. Para os leigos, os sorrisos mais atraentes foram aqueles com 0°, -5°, -10°, -15° e +5°. Para ambos os grupos, as pontuações mais baixas foram dadas para os sorrisos com torque de +10° e +15°. Ao comparar as percepções dos ortodontistas e leigos, não foram encontradas diferenças estatísticas na maioria das situações. Além disso, em geral, não houve diferença significativa entre as avaliações de face total e de sorriso aproximado. Conclusões: esses achados indicam que os sorrisos com variações unilaterais no torque do canino superior para palatino (valores negativos) foram mais tolerados do que os sorrisos com variações no torque da coroa para vestibular (valores positivos).

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INTRODUCTION: The attractiveness and facial aesthetics are commonly defined by the media in modern society and the number of patients seeking for changes in the facial appearance is progressively increasing. Augmented face convexity is believed to be non aesthetic and among the treatments available for its correction, the extraction of premolars followed by anterior teeth retraction produces a significant effect. However, it is questionable whether the procedure is reasonable in brown and black patients, since dental protrusion is considered a common morphological feature in these groups. METHODS: A photograph of a brown female subject was manipulated with image-editing program to generate a set of images with different degrees of labial retraction/protrusion. Two hundred individuals, randomly selected, were asked to rate each photograph and select which one showed the best aesthetic appearance. The survey was carried out in Salvador / Bahia (Brazil), which is a city with strong African slavery background and high proportion of brown and black population. RESULTS: Regardless of color, sex or income, the interviewees chose primarily the straight facial profile and secondarily the slightly concave or convex as more pleasant for a brown female individual (p< 0.05). The moderate and extreme convexity had the lowest scores (p< 0.05). CONCLUSIONS: It is suggested that among the accessed population, straight and slightly convex or concave profiles were preferred for a brown subject and moderate or excessive facial protrusion were not well accepted. It is expected that these data can guide orthodontists about the need for extraction to reduce dental protrusion in brown patients.

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ABSTRACT Introduction: The attractiveness and facial aesthetics are commonly defined by the media in modern society and the number of patients seeking for changes in the facial appearance is progressively increasing. Augmented face convexity is believed to be non aesthetic and among the treatments available for its correction, the extraction of premolars followed by anterior teeth retraction produces a significant effect. However, it is questionable whether the procedure is reasonable in brown and black patients, since dental protrusion is considered a common morphological feature in these groups. Methods: A photograph of a brown female subject was manipulated with image-editing program to generate a set of images with different degrees of labial retraction/protrusion. Two hundred individuals, randomly selected, were asked to rate each photograph and select which one showed the best aesthetic appearance. The survey was carried out in Salvador / Bahia (Brazil), which is a city with strong African slavery background and high proportion of brown and black population. Results: Regardless of color, sex or income, the interviewees chose primarily the straight facial profile and secondarily the slightly concave or convex as more pleasant for a brown female individual (p< 0.05). The moderate and extreme convexity had the lowest scores (p< 0.05). Conclusions: It is suggested that among the accessed population, straight and slightly convex or concave profiles were preferred for a brown subject and moderate or excessive facial protrusion were not well accepted. It is expected that these data can guide orthodontists about the need for extraction to reduce dental protrusion in brown patients.

RESUMO Introdução: a atratividade e a estética facial são comumente definidas pela mídia, na sociedade moderna, e o número de pacientes buscando mudar seu aspecto facial tem aumentado progressivamente. Acredita-se que a convexidade facial aumentada seja considerada não estética. Entre os tratamentos disponíveis para sua correção, figura, com destaque, a extração de pré-molares seguida da retração dos dentes anteriores. No entanto, é questionável se esse procedimento estaria indicado para indivíduos negros e pardos, visto que a protrusão dentária é considerada um achado morfológico comum nesses grupos. Métodos: a fotografia de um indivíduo pardo do sexo feminino foi manipulada em programa de edição de imagens, de forma a gerar um grupo de imagens com diferentes graus de protrusão ou retrusão labial. Duzentos indivíduos, selecionados aleatoriamente, avaliaram e foram solicitados a escolher a fotografia que melhor se apresentava esteticamente. Essa pesquisa foi executada em Salvador / Bahia (Brasil), que é uma cidade com marcante histórico de escravidão africana, apresentando elevada proporção de negros e pardos. Resultados: independentemente da cor, sexo ou renda, os entrevistados escolheram como mais estético, para um indivíduo pardo, o perfil reto, seguido do perfil levemente côncavo ou convexo (p< 0,05). Conclusões: dentro da amostra entrevistada, o perfil reto foi considerado mais estético para um indivíduo pardo, seguido do perfil levemente côncavo ou convexo. Os perfis moderadamente e excessivamente convexos foram considerados menos atraentes. Espera-se que esses achados possam guiar os ortodontistas no que diz respeito à necessidade de extrações dentárias, com intuito de reduzir a protrusão dentária/labial em pacientes pardos.

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INTRODUCTION:: The purpose of this study was to determine the perception of smile esthetics among orthodontists and layperson, with respect to different maxillary central incisors vertical positions in full-face and close-up smile analyses. METHODS:: Frontal photographs of the smiles of two adult women were used. Images were altered to create a symmetrical image with the gingival margin levels of the maxillary canines matching the central incisors and a 1.0-mm central-to-lateral incisal step. Later, the images were altered in order to create six different central incisor vertical positions in 0.5-mm increments. The images were randomly assembled in an album, which was given to 114 judges, 57 orthodontists and 57 laypersons, who were asked to evaluate the attractiveness of the images using the visual analog scale. The data collected were statistically analyzed by means of 1-way analysis of variance with the Tukey post-hoc test and the Student t test. RESULTS:: The highest rated smiles showed two notable characteristics: a) the central incisor gingival margins matched or were 0.5 mm below the line of the canine gingival margins and; b) the central-to-lateral incisal step was 1.0 to 1.5 mm. The worst smiles showed two notable characteristics: a) the central incisor gingival margins were 1.0 mm above or 1.5 mm below the canine gingival margins and; b) no step between the centrals and laterals or a 2.5-mm step. CONCLUSION:: The vertical position of the maxillary central incisors significantly affected the perception of the smile esthetics, whereas slightly extruded central incisors were more esthetically preferred than intruded.

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INTRODUCTION: Maxillary transverse deficiency is a highly prevalent malocclusion present in all age groups, from primary to permanent dentition. If not treated on time, it can aggravate and evolve to a more complex malocclusion, hindering facial growth and development. Aside from the occlusal consequences, the deficiency can bring about serious respiratory problems as well, due to the consequent nasal constriction usually associated. In growing patients, this condition can be easily handled with a conventional rapid palatal expansion. However, mature patients are frequently subjected to a more invasive procedure, the surgically-assisted rapid palatal expansion (SARPE). More recently, researches have demonstrated that it is possible to expand the maxilla in grown patients without performing osteotomies, but using microimplants anchorage instead. This novel technique is called microimplant-assisted rapid palatal expansion (MARPE). OBJECTIVE: The aim of the present article was to demonstrate and discuss a MARPE technique developed by Dr. Won Moon and colleagues at University of California - Los Angeles (UCLA). METHODS: All laboratory and clinical steps needed for its correct execution are thoroughly described. For better comprehension, a mature patient case is reported, detailing all the treatment progress and results obtained. CONCLUSION: It was concluded that the demonstrated technique could be an interesting alternative to SARPE in the majority of non-growing patients with maxillary transverse deficiency. The present patient showed important occlusal and respiratory benefits following the procedure, without requiring any surgical intervention.

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ABSTRACT INTRODUCTION: The purpose of this study was to determine the perception of smile esthetics among orthodontists and layperson, with respect to different maxillary central incisors vertical positions in full-face and close-up smile analyses. METHODS: Frontal photographs of the smiles of two adult women were used. Images were altered to create a symmetrical image with the gingival margin levels of the maxillary canines matching the central incisors and a 1.0-mm central-to-lateral incisal step. Later, the images were altered in order to create six different central incisor vertical positions in 0.5-mm increments. The images were randomly assembled in an album, which was given to 114 judges, 57 orthodontists and 57 laypersons, who were asked to evaluate the attractiveness of the images using the visual analog scale. The data collected were statistically analyzed by means of 1-way analysis of variance with the Tukey post-hoc test and the Student t test. RESULTS: The highest rated smiles showed two notable characteristics: a) the central incisor gingival margins matched or were 0.5 mm below the line of the canine gingival margins and; b) the central-to-lateral incisal step was 1.0 to 1.5 mm. The worst smiles showed two notable characteristics: a) the central incisor gingival margins were 1.0 mm above or 1.5 mm below the canine gingival margins and; b) no step between the centrals and laterals or a 2.5-mm step. CONCLUSION: The vertical position of the maxillary central incisors significantly affected the perception of the smile esthetics, whereas slightly extruded central incisors were more esthetically preferred than intruded.

RESUMO OBJETIVO: o objetivo do presente estudo foi avaliar a percepção da estética do sorriso, entre ortodontistas e leigos, em relação a diferentes posições verticais de incisivos centrais superiores, em análises de face completa e do sorriso aproximado. MÉTODOS: foram utilizadas fotografias frontais de sorrisos de duas mulheres adultas. As imagens foram alteradas para criar uma imagem simétrica, com o nível das margens gengivais dos caninos superiores igual ao dos incisivos centrais e um degrau incisal de 1,0 mm entre central e lateral. Posteriormente, as imagens foram alteradas para criar seis diferentes posições verticais de incisivos centrais, em incrementos de 0,5 mm. As imagens foram montadas aleatoriamente em um álbum, que foi dado a 114 avaliadores (57 ortodontistas e 57 leigos), que foram convidados a avaliar a atratividade das imagens usando uma escala analógica visual. Os dados coletados foram analisados estatisticamente por meio da análise de variância (ANOVA) de um fator com o teste post-hoc de Tukey e o teste t de Student. RESULTADOS: os sorrisos mais bem avaliados apresentaram duas características notáveis: a) as margens gengivais dos incisivos centrais corresponderam ou estavam 0,5 mm abaixo da linha das margens gengivais dos caninos; b) o degrau incisal entre central e lateral foi de 1,0 a 1,5 mm. Os piores sorrisos mostraram duas características notáveis: a) as margens gengivais dos incisivos centrais estavam 1,0 mm acima ou 1,5 mm abaixo das margens gengivais dos caninos e; b) nenhum degrau entre os centrais e laterais ou um degrau de 2,5 mm. CONCLUSÃO: a posição vertical dos incisivos centrais superiores afetou significativamente a percepção da estética do sorriso, ao passo que incisivos centrais ligeiramente extruídos foram mais preferidos esteticamente do que intruídos.

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ABSTRACT Introduction: Maxillary transverse deficiency is a highly prevalent malocclusion present in all age groups, from primary to permanent dentition. If not treated on time, it can aggravate and evolve to a more complex malocclusion, hindering facial growth and development. Aside from the occlusal consequences, the deficiency can bring about serious respiratory problems as well, due to the consequent nasal constriction usually associated. In growing patients, this condition can be easily handled with a conventional rapid palatal expansion. However, mature patients are frequently subjected to a more invasive procedure, the surgically-assisted rapid palatal expansion (SARPE). More recently, researches have demonstrated that it is possible to expand the maxilla in grown patients without performing osteotomies, but using microimplants anchorage instead. This novel technique is called microimplant-assisted rapid palatal expansion (MARPE). Objective: The aim of the present article was to demonstrate and discuss a MARPE technique developed by Dr. Won Moon and colleagues at University of California - Los Angeles (UCLA). Methods: All laboratory and clinical steps needed for its correct execution are thoroughly described. For better comprehension, a mature patient case is reported, detailing all the treatment progress and results obtained. Conclusion: It was concluded that the demonstrated technique could be an interesting alternative to SARPE in the majority of non-growing patients with maxillary transverse deficiency. The present patient showed important occlusal and respiratory benefits following the procedure, without requiring any surgical intervention.

RESUMO Introdução: a deficiência transversa da maxila é uma má oclusão com alta prevalência em todas as faixas etárias, da dentição decídua à permanente. Se não for corrigida, pode agravar-se com o passar do tempo, prejudicando o crescimento e desenvolvimento facial. Além dos prejuízos oclusais, essa deficiência pode trazer problemas respiratórios também severos, devido à consequente constrição da cavidade nasal. Em pacientes em crescimento, a sua resolução é relativamente simples, por meio da expansão rápida convencional da maxila. Porém, os pacientes já maduros geralmente são encaminhados para um procedimento mais invasivo, a expansão rápida de maxila assistida cirurgicamente (SARPE). Mais recentemente, pesquisadores têm demonstrado que é possível executar a expansão palatal esquelética em pacientes adultos sem auxílio de osteotomias, mas sim com auxílio de mini-implantes. Essa técnica é denominada Microimplant-Assisted Rapid Palatal Expansion, ou MARPE. Objetivo: o objetivo do presente artigo é demonstrar e discutir uma das técnicas disponíveis de MARPE, desenvolvida por Won Moon e colaboradores, na University of California, Los Angeles (UCLA). Métodos: a técnica encontra-se detalhadamente descrita, com as etapas laboratoriais e clínicas que devem ser seguidas para sua correta execução. Para descrevê-la, é apresentado o caso clínico de uma paciente adulta, detalhando toda a sequência do tratamento e os resultados obtidos. Conclusão: a técnica apresentada pode ser uma alternativa não invasiva à SARPE na resolução da deficiência transversa de maxila, podendo ser empregada na maioria dos pacientes com crescimento facial finalizado. A paciente apresentada demonstrou benefícios significativos nos aspectos oclusal e respiratório, sem a necessidade de intervenção cirúrgica.

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