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Biomedical subjects

Carlos Flores-Mir

Publications and source records attributed to Carlos Flores-Mir.

At least 19 recordsLinked to original sources
PubMed2006

A systematic review of cephalometric facial soft tissue changes with the Activator and Bionator appliances in Class II division 1 subjects.

The objective of the present systematic review was to evaluate, through lateral cephalograms, facial soft tissue changes after the use of the Activator and Bionator appliances in Class II division 1 malocclusion subjects. Several electronic databases (PubMed, Medline, Medline In-Process and Other Non-Indexed Citations, Cochrane Database, Embase, Web of Sciences, and Lilacs) were searched with the assistance of a senior health sciences librarian. Abstracts, which appeared to fulfil the initial criteria, were selected by consensus. The original articles were then retrieved. Their references were also hand searched for possible missing articles. Clinical trials, which assessed facial soft tissue changes with the use of either an Activator or a Bionator appliance without any surgical intervention or syndromic characteristics, were considered. A comparable untreated control group was required to factor out normal growth changes. Five articles using the Activator and six using the Bionator fulfilled the selection criteria and quantified facial soft tissue changes. An individual analysis of these articles was undertaken and some methodological flaws were identified. Based on the available evidence, a significant amount of controversy regarding the soft tissue changes produced by the Activator and the Bionator exists. Soft tissue changes that were reported as being statistically significant were of questionable clinical significance. Long-term, double-blinded, prospective randomized clinical trials are needed to confirm the findings. Three-dimensional quantification is also required to overcome current limitations in our understanding of the soft tissue changes obtained with the use of removable functional appliances.

Activator Appliances↗
PubMed2006

Normative and self-perceived orthodontic treatment need of a Peruvian university population.

BACKGROUND: Previous studies on orthodontic treatment need in young adults have shown that up to 50% had malocclusions that needed orthodontic treatment. The aims of this study were to assess the normative and self-perceived need for orthodontic treatment using the Index of Orthodontic Treatment Need (IOTN) and to determine if the treatment need levels were influenced by sex, age and socio-economic status (SES) in a sample of Peruvian young adults. METHODS: 281 first-year students (157 male and 124 female students) with a mean age of 18.1 +/- 1.6 years were randomly selected and evaluated through the Dental Health Component (DHC) and Aesthetic Component (AC) of the IOTN. Structured interview and clinical examination were used to assess the students. Descriptive statistics and Chi-square tests were used for data analysis with statistical significance set at P < 0.05. RESULTS: An intra-examiner reliability of 0.89 was obtained (weighted Kappa). The percentage of students according to SES was 51.2%, 40.6% and 8.2% corresponding to low, medium and high SES respectively. The percentage of students with DHC grades 4-5 was 29.9% whereas the percentage of students with AC grades 8-10 was 1.8%. There were no significant differences in the distribution of normative and self-perceived orthodontic treatment need based on sex, age and SES comparisons. CONCLUSION: Normative orthodontic treatment need was not matched by a similar level of self-perceived treatment need in these young adults. Sex, age and SES were non-significant factors associated with levels of treatment need.

Adolescent↗
PubMed2006

Estimating arch length discrepancy through Little's Irregularity Index for epidemiological use.

The objective of this study was to evaluate the diagnostic capability of Little's Irregularity Index (LII) in order to estimate the arch length discrepancy (ALD) in a dental arch. Dental casts with a full permanent dentition, excluding third molars, from 200 12- to-16-year-old schoolchildren from a representative high school located in Lima, Peru, were used. Incisal irregularity was measured using the LII, whereas ALD was calculated as the difference between available and required space in each dental arch anterior to the first permanent molars. The receiver-operator characteristic (ROC) curve was used to contrast the LII with three different dichotomized ALDs and locate optimized cut-off points. Correlation between ALD and LII was -0.68 (P < 0.001). According to ROC curves, LIIs of 2.45, 4.00, and 4.55 mm were the optimized cut-off points to estimate negative ALDs higher than 0, 3, and 6 mm, respectively. LII's highest diagnostic capability was found for estimating negative ALD greater than 3 mm with a sensibility of 0.78 and a specificity of 0.76. Based on the present findings, LII could potentially be used in epidemiological surveys as a valid and less time-consuming measurement of crowding compared with ALD; however, further studies are needed to test the reliability of this approach in field settings.

Adolescent↗
PubMed2006

Validity, reliability, and reproducibility of plaster vs digital study models: comparison of peer assessment rating and Bolton analysis and their constituent measurements.

INTRODUCTION: The objective of this validation study was to compare standard plaster models (the current gold standard for cast measurements) with their digital counterparts made with emodel software (version 6.0, GeoDigm, Chanhassen, Minn) for the analysis of tooth sizes and occlusal relationships--specifically the Bolton analysis and the peer assessment rating (PAR) index and their components. METHODS: Dental casts were poured from 24 subjects with 8 malocclusion types grouped according to American Board of Orthodontics categories. Measurements were made with a digital caliper to the nearest 0.01 mm from plaster models and with the software from the digital models. A paired samples t test was used to compare reliability and validity of measurements between plaster and digital methods. RESULTS: Reproducibility of digital models via the concordance correlation coefficient was excellent in most cases and good in some. Although statistically significant differences in some measurements were found for the reliability and validity of the digital models via the average mean of the absolute differences of repeated measurements, none was clinically significant. Grouping of the measurements according to the 8 American Board of Orthodontics categories produced no significant difference (Kruskal-Wallis test). No measurement associated with Bolton analysis or PAR index made on plaster vs digital models showed a clinically significant difference. The PAR analysis and its constituent measurements were not significantly different clinically between plaster and emodel media. CONCLUSIONS: Preliminary results did not indicate that digital models would cause an orthodontist to make a different diagnosis of malocclusion compared with plaster models; digital models are not a compromised choice for treatment planning or diagnosis.

Computer Simulation↗
PubMed2006

Longitudinal study of temporomandibular joint disc status and craniofacial growth.

INTRODUCTION: The objective of this retrospective cohort study was to assess the association of temporomandibular joint (TMJ) disc status and craniofacial growth. METHODS: Seventy-nine subjects (52 female, 27 male) with and without TMJ disc abnormalities were followed for a mean time of 3 years 8 months. Of this sample, 40 subjects (21 female, 19 male) received orthodontic treatment. Disc displacement and disc length measurements from magnetic resonance imaging of the jaw joints were used to evaluate TMJ disc status. A principal component analysis was used to produce a single disc status score per subject. Horizontal and vertical growth changes were obtained from cephalometric radiographs. The Fishman skeletal maturation index system was used to obtain the percentage of the total craniofacial growth attained. In addition, previous orthodontic treatment and time frames between the follow-up cephalometric radiographs were considered. RESULTS: A stepwise multiple linear regression analysis was used to evaluate the influence of TMJ disc status and orthodontic treatment on the displacement vectors between initial records (T1) and final records (T2) for each cephalometric point. Less horizontal and vertical growth was found in specific regions of the maxilla and the mandible in subjects with TMJ disc abnormalities, although their respective determination coefficients were mild (R2 <11.2%). CONCLUSIONS: TMJ disc abnormality was associated with reduced forward growth of the maxillary and mandibular bodies. TMJ disc abnormality was associated with reduced downward growth of the mandibular ramus.

Cephalometry↗
PubMed2006

True molar intrusion attained during orthodontic treatment: a systematic review.

INTRODUCTION: The aim of this systematic review was to quantify the amount of true molar intrusion attainable during orthodontic treatment. METHODS: A literature search was conducted to identify clinical trials that assessed true molar intrusion through superimposition of lateral cephalogram tracings. Craniofacial growth had to be factored out when appropriate. Electronic databases (Pubmed, Medline, Medline In-Process & Other Non-Indexed Citations, all EBM reviews, Embase, Web of Science, and Lilacs) were searched with the help of a senior health-sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected, and the full-text original articles were then retrieved and analyzed. Only articles that fulfilled the final selection criteria were finally considered. Their references were also hand-searched for possible missing articles from the database searches. RESULTS: Thirty abstracts met the initial inclusion criteria, and these articles were retrieved. From these, 29 were later rejected because they did not either quantify true molar intrusion or factor out normal craniofacial growth when required. Only 1 article remained, and it showed a mean maxillary molar intrusion of 0.96 mm (SD, 0.54) in 12 subjects. CONCLUSIONS: True molar intrusion appears to be achievable in the maxillary arch, although the amount of evidence is minimal. The clinical significance of the magnitude of the true intrusion reported is questionable as the sole treatment option to correct open-bite malocclusions. Better quantification method of the true intrusion attained has to be utilized.

Clinical Trials as Topic↗
PubMed2006

Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a systematic review.

INTRODUCTION: Our objective was to evaluate the capability of lateral cephalograms in diagnosing hypertrophied adenoids and obstructed posterior nasopharyngeal airways. METHODS: A systematic review of the literature by using several electronic databases (Cochrane Library, Medline, Medline in progress, PubMed, Web of Science, Embase, and Lilacs) was performed with the help of a senior health-sciences librarian. The electronic search was followed up with hand searches. After applying our inclusion-exclusion criteria, the search yielded 11 articles that were then scored based on their methodological validity. RESULTS: Lateral cephalograms performed reasonably well in evaluating adenoid size; both quantitative measures of adenoid area and subjective grading of adenoid size on lateral cephalograms had reasonable correlations to actual adenoid size (range of r, 0.60 to 0.88). However, evidence suggested that cephalograms were less ideal for evaluating the size of the posterior nasopharyngeal airway. The diagnostic difference is likely because the adenoid is a simpler 3-dimensional structure than the nasopharynx; therefore, it loses less information when compressed into 2 dimensions by the radiograph. CONCLUSIONS: Being used as a screening tool to determine the need for more rigorous ENT follow-up appears to be the greatest utility of lateral cephalograms. Because no consensus could be reached on what are the most useful landmarks, we recommend that clinicians look for multiple deviant measures of adenoid size rather than one definitive quantification.

Adenoids↗
PubMed2006

In vivo comparison of force decay between injection molded and die-cut stamped elastomers.

INTRODUCTION: Elastomeric chains are used extensively in orthodontic treatment, and their clinical behavior should be evaluated in vivo. The aim of this randomized clinical trial was to determine whether elastomeric chains made by different fabrication procedures have different force-decay levels. METHODS: Twenty-four consecutive orthodontic patients at a university orthodontic clinic who fulfilled the selection criteria were grouped to evaluate force decay at 1 hour, 24 hours, 48 hours, 7 days, 14 days, and 21 days. Oral hygiene and diet pH (between 5.8 and 7) were controlled. For each patient, 2 types of elastomeric chains (injection molded and die-cut stamped) made by the same company were randomly assigned to a different arch and arch side (split-mouth design). Each traction unit (3-piece elastomeric chain with ligature wire) was adjusted to deliver an initial calibrated force of 200 g during canine retraction. This force level was reactivated for each study period with a new calibrated traction unit. Mean and standard deviations for the force decay in grams and percentages were calculated. Student t tests for independent and paired samples were used. RESULTS: No statistically significant difference was found in the force decay between elastomeric chain types during the 3-week study period. The mean remaining force (about 150 g) after 3 weeks was considered clinically adequate for canine retraction. The behavior of the elastomeric chains in both arches was statistically and clinically similar. CONCLUSIONS: Both types of elastomeric chain produced the same clinical effects.

Cuspid↗
PubMed2006

Search and selection methodology of systematic reviews in orthodontics (2000-2004).

INTRODUCTION: More systematic reviews related to orthodontic topics are published each year, although little has been done to evaluate their search and selection methodologies. METHODS: Systematic reviews related to orthodontics published between January 1, 2000, and December 31, 2004, were searched for their use of multiple electronic databases and secondary searches. The search and selection methods of identified systematic reviews were evaluated against the Cochrane Handbook's guidelines. RESULTS: Sixteen orthodontic systematic reviews were identified in this period. The percentage of reviews documenting and using each criterion of article searching has changed over the last 5 years, with no recognizable directional trend. On average, most systematic reviews documented their electronic search terms (88%) and inclusion-exclusion criteria (100%), and used secondary searching (75%). Many still failed to search more than MEDLINE (56%), failed to document the database names and search dates (37%), failed to document the search strategy (62%), did not use several reviewers for selecting studies (75%), and did not include all languages (81%). CONCLUSIONS: The methodology of systematic reviews in orthodontics is still limited, with key methodological components frequently absent or not appropriately described.

Databases, Bibliographic↗
PubMed2006

Correlation of skeletal maturation stages determined by cervical vertebrae and hand-wrist evaluations.

The aim of this study was to assess the correlation between the Fishman maturation prediction method (FMP) and the cervical vertebral maturation (CVM) method for skeletal maturation stage determination. Hand-wrist and lateral cephalograms from 79 subjects (52 females and 27 males) were used. Hand-wrist radiographs were analyzed using the FMP to determine skeletal maturation level (advanced, average, or delayed) and stage (relative position of the individual in the pubertal growth curve). Cervical vertebrae (C2, C3, and C4) outlines obtained from lateral cephalograms were analyzed using the CVM to determine skeletal maturation stage. Intraexaminer reliability (Intraclass correlation coefficient [ICC]) for both methods was calculated from 10 triplicate hand-wrist and lateral cephalograms from the same patients. An ICC coefficient of 0.985 for FMP and an ICC of 0.889 for CVM were obtained. A Spearman correlation value of 0.72 (P < .001) was found between the skeletal maturation stages of both methods. When the sample was subgrouped according to skeletal maturation level, the following correlation values were found: for early mature adolescents 0.73, for average mature adolescents 0.70, and for late mature adolescents 0.87. All these correlation values were statistically different from zero (P < .024). Correlation values between both skeletal maturation methods were moderately high. This may be high enough to use either of the methods indistinctively for research purposes but not for the assessment of individual patients. Skeletal level influences the correlation values and, therefore, it should be considered whenever possible.

Adolescent↗
PubMed2006

Dental morphology and crowding. A multivariate approach.

The objective of this study was to compare, combined and individually, the mesiodistal (MD) and buccolingual (BL) tooth sizes as well as their respective crown proportions in the permanent dentition in dental arches with moderate, mild, and no crowding. Dental casts from two-hundred 12 to 16-year-old school children from a typical high school from Lima, Peru, were used. The MD and BL tooth sizes of all permanent teeth except second and third molars were measured, and their crown proportion (MD/BL ratio) was estimated. Each dental arch was classified as presenting moderate (-5.1 mm or more of discrepancy), mild (-0.1 and -5 mm of discrepancy), and no crowding (zero or a positive discrepancy). Combined and tooth-specific comparisons among the crowding groups for the tooth sizes as well as crown proportions were performed with a multivariate analysis of variance (MANOVA, using Wilks lambda). Combined MD tooth sizes and crown proportions differed among crowding groups. Subsequent individual comparisons indicated differences for MD tooth size of all upper teeth and for lower premolars and central incisors. Differences were also detected for crown proportions of the upper second premolar, canine, and both incisors; as well as for the lower first premolar, canine, and central incisor. No differences were found for the BL tooth sizes among crowding groups. MD tooth sizes and crown proportions from specific teeth are significantly different between dental arches with moderate, mild, and noncrowded arches. This study helps to understand the odontometric component of the dental crowding multifactorial origin.

Adolescent↗
PubMed2006

Canadian orthodontist Internet user profile.

An anonymous, self-administered, mail-out survey of Canadian Orthodontists was conducted to evaluate the characteristics of orthodontic Internet use. The response rate was 45.6% (304 of 667). A total of 76.6% of orthodontists reported having Internet access at work, and an additional 12.4% reported having Internet access from a different location. Statistically significant associations between Internet usage and office staff size (P < .001) and years of practice (P = .046) were observed. Offices with larger staffs had greater Internet access. Number of staffs and number of case starts were positively correlated (P < .001, r = 0.498). The odds ratio for having Internet access on the basis of increased case starts from the less than 100 to 300-399 categories was 5.67. Although not statistically significant, there was a trend for greater Internet access by younger practitioners.

Adult↗
PubMed2006

Dental esthetic self-perception in young adults with and without previous orthodontic treatment.

The aim of this study was to determine which dental esthetic self-perception evaluation tool discriminated better between orthodontically treated or untreated Peruvian young adults. A total of 630 students were randomly chosen from the 2000 admitted in 2002 to a private university in Peru. Students undergoing active orthodontic treatment at the time of examination were excluded. Self-perceived dental esthetic appearance was evaluated through Standardized Continuum of Aesthetic Need, Oral Aesthetic Subjective Index Scale, and Visual Analogue Scale (VAS). A stepwise multivariate discriminant analysis was developed to classify orthodontic treatment according to the three evaluation tools. A total of 199 students (31.6%) reported a history of orthodontic treatment. Differences between orthodontically treated and untreated groups were found only for the mean VAS score (P < .001). Although three different approaches were used to evaluate dental esthetic self-perception, only VAS allowed the discrimination of the self-perceived dental appearance between orthodontically treated and untreated Peruvian university young adults. Similarities in the self-perceived dental appearance of treated and untreated groups reported in previous epidemiological studies could be explained because different evaluation instruments were used. Further studies are required to support current findings.

Adolescent↗
PubMed2006

Orthodontic treatment need in Peruvian young adults evaluated through dental aesthetic index.

The objectives of this study were to evaluate the frequency and severity of the malocclusion and treatment needs in Peruvian young adults. The second aim was to compare the orthodontic treatment needs according to sex and socio-economic status (SES). This cross-sectional study was conducted at the University Dental Clinic of a private university in Lima, Peru. A total of 267 freshmen (from 16 to 25 years old) were randomly selected from a pool of 780 students. Students wearing an orthodontic appliance or reporting a history of orthodontic treatment were excluded from the study. Clinical examinations were conducted using the Dental Aesthetic Index (DAI). Mann-Whitney and Kruskal-Wallis tests were used to compare the DAI scores according to sex and SES, respectively. The mean DAI score was 28.87 points (IC(95%) 27.77; 29.97, where IC indicates interval of confidence). Around one-third of the sample presented severe or very severe malocclusion, which implies a highly desirable or mandatory orthodontic treatment need. No statistically significant difference was found between the DAI scores according to sex (P = .592) and SES (P = .397). Approximately one-third of the evaluated Peruvian young adults would need orthodontic treatment according to the DAI. In this population, malocclusion was characterized by a relatively high frequency of missing teeth, appreciable dental crowding, and inadequate anteroposterior relationships.

Adolescent↗
PubMed2006

Soft tissue changes with fixed functional appliances in Class II division 1.

OBJECTIVE: To evaluate facial soft tissue changes after the use of fixed functional appliances in Class II division 1 malocclusion cases using a systematic review of the literature. MATERIALS AND METHODS: Several electronic databases (PubMed, Medline, Medline In-Process & Other Non-Indexed Citations, Cochrane Database, Embase, Web of Sciences, and Lilacs) were searched with the help of a senior Health Sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected by consensus. The original articles were then retrieved. Their references were also hand-searched for possible missing articles. Clinical trials assessing facial soft tissue changes with the use of fixed functional appliances without any surgical intervention or syndromic characteristics were considered. A comparable untreated control group was required to factor out normal growth changes. Four articles using Herbst and one using Jasper Jumper fulfilled the selection criteria. An individual analysis of these articles was made and some methodological flaws were identified. RESULTS: Although fixed functional appliances produce some significant statistical changes in the soft tissue profile, the magnitude of the changes may not be perceived as clinically significant. CONCLUSIONS: The conclusions from this systematic review should be considered with caution because only a secondary level of evidence was found. Long-term double-blinded prospective randomized clinical trials are needed. Three-dimensional quantification of the soft tissue changes is required to overcome current limitations in our understanding of the soft tissue changes obtained with the use of fixed functional appliances.

Activator Appliances↗
PubMed2006

Cephalometric facial soft tissue changes with the twin block appliance in Class II division 1 malocclusion patients. A systematic review.

OBJECTIVE: To evaluate facial soft tissue changes after the use of the twin block appliance in Class II division 1 malocclusion patients. MATERIALS AND METHODS: Several electronic databases (PubMed, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cochrane databases, EMBASE, Web of Science, and LILACS) were searched with the help of a senior health-sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected by consensus, and the original articles were retrieved. The article references were hand-searched for possible missing articles. Clinical trials that assessed facial soft tissue changes with the use of the twin block appliance without any surgical intervention or syndromic characteristics were considered. A comparable untreated control group was required to factor out normal growth changes. RESULTS: Two articles fulfilled the selection criteria and quantified facial soft tissue changes. Although some statistically significant changes in the soft tissue profile were found, the magnitude of the changes may not be perceived as clinically significant. Changes produced in the upper lip seem to be controversial, although the study with sounder methodological quality did not report significant changes. No change in the anteroposterior position of the lower lip and the soft tissue menton or improvement of the facial convexity was found. CONCLUSIONS: Three-dimensional quantification of the soft tissue changes is required to overcome current limitations in our understanding of the soft tissue changes obtained after the use of the twin block appliance in Class II division 1 malocclusion patients.

Cephalometry↗