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INTRODUCTION: A significant increase in the number of adults in search of orthodontic treatment has raised a new challenge for orthodontists: the need to interact with other specialties to achieve excellent results, particularly when dealing with smile aesthetics and facial balance. Several factors should be considered to respond to their demand: adequate tooth leveling and alignment, individual tooth proportions between adjacent teeth and their contralateral teeth, shape and natural appearance of each tooth and gingival architecture, which should all be in agreement with facial harmony. Maxillary or mandibular incisors congenitally missing or lost due to caries or trauma and tooth-size discrepancies (Bolton) are some of the important aesthetic challenges for an integrated orthodontic treatment. OBJECTIVES: This study describes cases that illustrate the clinical challenges of treating the anterior area, as well as the multidisciplinary strategies required for their resolution. CONCLUSION: The increasingly frequent multidisciplinary orthodontic treatments of complex cases seem to effectively maximize aesthetic and functional results using a combination of procedures conducted by specialists in related areas, such as Surgery, Prosthetics, Implantology, Restorative Dentistry and Periodontics.

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ABSTRACT Introduction: A significant increase in the number of adults in search of orthodontic treatment has raised a new challenge for orthodontists: the need to interact with other specialties to achieve excellent results, particularly when dealing with smile aesthetics and facial balance. Several factors should be considered to respond to their demand: adequate tooth leveling and alignment, individual tooth proportions between adjacent teeth and their contralateral teeth, shape and natural appearance of each tooth and gingival architecture, which should all be in agreement with facial harmony. Maxillary or mandibular incisors congenitally missing or lost due to caries or trauma and tooth-size discrepancies (Bolton) are some of the important aesthetic challenges for an integrated orthodontic treatment. Objectives: This study describes cases that illustrate the clinical challenges of treating the anterior area, as well as the multidisciplinary strategies required for their resolution. Conclusion: The increasingly frequent multidisciplinary orthodontic treatments of complex cases seem to effectively maximize aesthetic and functional results using a combination of procedures conducted by specialists in related areas, such as Surgery, Prosthetics, Implantology, Restorative Dentistry and Periodontics.

RESUMO Introdução: O aumento significativo de indivíduos adultos em busca de tratamento ortodôntico resultou em um novo desafio para o ortodontista: a necessidade de interação com outras especialidades, visando a excelência de resultados, principalmente quando o assunto é a estética do sorriso e o equilíbrio facial. Para atender a essa demanda, diversos fatores devem ser considerados: correto alinhamento e nivelamento dos dentes, proporções dentárias individuais entre dentes adjacentes e seus homólogos, forma e naturalidade de cada dente e arquitetura gengival - estando todos esses em consonância com a harmonia da face. Casos envolvendo ausência congênita ou perda de incisivos por cárie ou trauma, discrepância de tamanho dentário (Bolton), entre outras, constituem importantes desafios estéticos para o tratamento integrado em Ortodontia. Objetivos: apresentar casos que ilustram tais desafios envolvendo a região anterior, onde a abordagem transdisciplinar foi fundamental para sua resolução. Conclusão: O tratamento ortodôntico transdisciplinar, cada vez mais frequente, vem se mostrando eficiente na resolução de casos complexos, visando maximizar os resultados estéticos e funcionais, mediante a combinação de procedimentos realizados por especialidades afins, como a Cirurgia, Prótese, Implantodontia, Dentística e Periodontia.

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INTRODUCTION:: Due to the increasing use of miniplates for anchorage purposes in orthodontics, it is very important to know more about infrazigomatic crest anatomy (thickness), in adult patients. OBJECTIVES:: Evaluate the infrazygomatic crest region thickness, in adult (male and female) patients. METHODS:: Cone-beam computerized tomography (CBCT) images from 40 patients were used to assess cross-sectional measurements of the infrazygomatic crest region. Measurement 1 considered thickness 2 mm above the distobuccal root of the permanent maxillary first molar, while measurement 2 was taken 2 mm above the first measurement. RESULTS:: The mean thickness of the infrazygomatic crest in males was 3.55 mm for measurement 1 and 2.84 mm for measurement 2, while in females these were 2.37 mm and 2.24 mm, respectively. CONCLUSION:: The authors concluded that the overall mean thickness of the infrazygomatic crest was 2.49 mm with respect to measurement 1, and 2.29 mm for measurement 2, with no statistically significant differences between gender.

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ABSTRACT Introduction: Due to the increasing use of miniplates for anchorage purposes in orthodontics, it is very important to know more about infrazigomatic crest anatomy (thickness), in adult patients. Objectives: Evaluate the infrazygomatic crest region thickness, in adult (male and female) patients. Methods: Cone-beam computerized tomography (CBCT) images from 40 patients were used to assess cross-sectional measurements of the infrazygomatic crest region. Measurement 1 considered thickness 2 mm above the distobuccal root of the permanent maxillary first molar, while measurement 2 was taken 2 mm above the first measurement. Results: The mean thickness of the infrazygomatic crest in males was 3.55 mm for measurement 1 and 2.84 mm for measurement 2, while in females these were 2.37 mm and 2.24 mm, respectively. Conclusion: The authors concluded that the overall mean thickness of the infrazygomatic crest was 2.49 mm with respect to measurement 1, and 2.29 mm for measurement 2, with no statistically significant differences between gender.

RESUMO Introdução: devido ao aumento do uso de miniplacas para ancoragem em Ortodontia, torna-se de fundamental importância compreender melhor a anatomia da crista infrazigomática (espessura) em pacientes adultos. Objetivos: avaliar a espessura da crista infrazigomática em pacientes adultos (sexos feminino e masculino). Métodos: foram utilizadas tomografias computadorizadas de feixe cônico (TCFC) de 40 pacientes, para avaliar medidas da região da crista infrazigomática, no sentido transversal. A Medida 1 verificou a espessura mm acima da raiz distovestibular do primeiro molar permanente superior, enquanto a Medida 2 foi realizada 2 mm acima da primeira medida. Resultados: a espessura média da crista infrazigomática encontrada no sexo masculino foi de 3,55 mm para a Medida 1 e de 2,84 mm para a Medida 2, e no sexo feminino foi de 2,37 mm e de 2,24 mm, respectivamente. Conclusão: os autores puderam constatar que a espessura média da crista infrazigomática foi de 2,49 mm para a Medida 1, e de 2,29 mm para a Medida 2, sem diferença estatisticamente significativa entre os sexos.

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OBJECTIVE: The purpose of this laboratory study was to evaluate changes in the pigmentation of esthetic elastomeric ligatures after immersion in a staining solution. METHODS: Sixty ligatures were selected and divided into 12 groups according to their brand and also considering their condition, i.e., unstretched or stretched. The groups were divided into: Morelli (clear), TP Orthodontics (clear), American Orthodontics (clear), 3M/Unitek (clear), American Orthodontics (pearl color) and 3M/Unitek (pearl color), separated in groups of 5 unstretched and 5 stretched ligatures. Assessment of their color changes was performed by means of digital photograph and computer analysis using Adobe Photoshop. Standardized digital photographs were taken at T0 (before the staining process, with unstretched ligatures) and at T1 (following the 5-days staining process). The staining solution was composed of artificial saliva and foods with staining potential. At T1 the ligatures were either stretched or unstretched. RESULTS: The results of this study showed that esthetic elastomeric ligatures are prone to staining. Among the evaluated brands, TP Orthodontics and American Orthodontics clear ligatures were the most stable. Moreover, 3M/Unitek pearl ligatures demonstrated statistically significant changes in all variables. CONCLUSIONS: Esthetic elastomeric ligatures are susceptible to staining and no statistically significant difference was found between unstretched or stretched ligatures, with the sole exception of the TP Orthodontics brand. The 3M/Unitek's pearl color ligatures displayed the greatest staining potential.

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INTRODUCTION: Compensatory orthodontic treatment, or simply orthodontic camouflage, consists in an important alternative to orthognathic surgery in the resolution of skeletal discrepancies in adult patients. It is important to point that, to be successfully performed, diagnosis must be detailed, to evaluate, specifically, dental and facial features, as well as the limitations imposed by the magnitude of the discrepancy. The main complaint, patient's treatment expectation, periodontal limits, facial pattern and vertical control are some of the items to be explored in the determination of the viability of a compensatory treatment. Hyperdivergent patients who present with a Class III skeletal discrepancy, associated with a vertical facial pattern, with the presence or tendency to anterior open bite, deserve special attention. In these cases, an efficient strategy of vertical control must be planned and executed. OBJECTIVE: The present article aims at illustrating the evolution of efficient alternatives of vertical control in hiperdivergent patients, from the use, in the recent past, of extraoral appliances on the lower dental arch (J-hook), until nowadays, with the advent of skeletal anchorage. But for patients with a more balanced facial pattern, the conventional mechanics with Class III intermaxillary elastics, associated to an accentuated curve of Spee in the upper arch and a reverse curve of Spee in the lower arch, and vertical elastics in the anterior region, continues to be an excellent alternative, if there is extreme collaboration in using the elastics.

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OBJECTIVE: The purpose of this laboratory study was to evaluate changes in the pigmentation of esthetic elastomeric ligatures after immersion in a staining solution. METHODS: Sixty ligatures were selected and divided into 12 groups according to their brand and also considering their condition, i.e., unstretched or stretched. The groups were divided into: Morelli (clear), TP Orthodontics (clear), American Orthodontics (clear), 3M/Unitek (clear), American Orthodontics (pearl color) and 3M/Unitek (pearl color), separated into groups of 5 unstretched and five stretched ligatures. Assessment of their color changes was performed by means of digital photograph and computer analysis using Adobe Photoshop. Standardized digital photographs were taken at T0 (before the staining process, with unstretched ligatures) and at T1 (following the 5-days staining process). The staining solution was composed of artificial saliva and foods with staining potential. At T1 the ligatures were either stretched or unstretched. RESULTS: The results of this study showed that esthetic elastomeric ligatures are prone to staining. Among the evaluated brands, TP Orthodontics and American Orthodontics clear ligatures were the most stable. Moreover, 3M/Unitek pearl ligatures demonstrated statistically significant changes in all variables. CONCLUSIONS: Esthetic elastomeric ligatures are susceptible to staining and no statistically significant difference was found between unstretched or stretched ligatures, with the sole exception of the TP Orthodontics brand. The 3M/Unitek's pearl color ligatures displayed the greatest staining potential.

OBJETIVO: avaliar alterações da pigmentação de ligaduras elásticas estéticas após imersão em solução de pigmentação. MÉTODOS: Sessenta ligaduras foram selecionadas e divididas em doze grupos de acordo com a marca comercial utilizada e nas condições normal e distendida. Os grupos foram divididos em: Morelli transparente, TP Orthodontics transparente, American Orthodontics transparente, Unitek/3M transparente, American Orthodontics pérola e Unitek/3M pérola, separados quanto à condição normal e distendida, totalizando 5 ligaduras em cada condição. A avaliação das mudanças de coloração foi realizada por meio de fotografia digital e análise computadorizada usando o programa Adobe Photoshop. Foram realizadas fotografias digitais padronizadas nos tempos T0 - antes do processo de pigmentação, com as ligaduras em estado normal; e T1 - após o processo de pigmentação, que durou cinco dias. A solução de pigmentação utilizada foi composta por saliva artificial e por alimentos que possuem potencial de coloração. No tempo T1, as ligaduras se encontravam em estado distendido e em estado normal (sem distensão). RESULTADO: os resultados do presente estudo demonstraram que ligaduras elásticas estéticas são suscetíveis à pigmentação. Dentre as marcas comerciais avaliadas a TP Orthodontics e American Orthodontics transparente foram as mais estáveis. Já a Unitek/3M pérola demonstrou alterações estatisticamente significativas em todas as variáveis avaliadas. CONCLUSÃO: ligaduras elásticas estéticas são suscetíveis à pigmentação, não havendo diferença estatisticamente significativa entre o estado normal e o estado distendido, com exceção na marca TP Orthodontics. A marca Unitek/3M pérola demonstrou ser a que apresenta maior potencial para pigmentação.

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INTRODUCTION: Compensatory orthodontic treatment, or simply orthodontic camouflage, consists in an important alternative to orthognathic surgery in the resolution of skeletal discrepancies in adult patients. It is important to point that, to be successfully performed, diagnosis must be detailed, to evaluate, specifically, dental and facial features, as well as the limitations imposed by the magnitude of the discrepancy. The main complaint, patient's treatment expectation, periodontal limits, facial pattern and vertical control are some of the items to be explored in the determination of the viability of a compensatory treatment. Hyperdivergent patients who carry a Class III skeletal discrepancy, associated with a vertical facial pattern, with the presence or tendency to anterior open bite, deserve special attention. In these cases, an efficient strategy of vertical control must be planned and executed. OBJECTIVE: The present article aims at illustrating the evolution of efficient alternatives of vertical control in hiperdivergent patients, from the use, in the recent past, of extra-oral appliances on the lower dental arch (J-hook), until nowadays, with the advent of skeletal anchorage. But for patients with a more balanced facial pattern, the conventional mechanics with Class III intermaxillary elastics, associated to an accentuated curve of Spee in the upper arch and a reverse Curve of Spee in the lower arch, and vertical elastics in the anterior region, continues to be an excellent alternative, if there is extreme collaboration in using the elastics.

INTRODUÇÃO: o tratamento ortodôntico compensatório, ou simplesmente camuflagem ortodôntica, consiste em uma importante alternativa à cirurgia ortognática na resolução de discrepâncias esqueléticas em pacientes adultos. Torna-se importante salientar que, para ser instituído de maneira bem-sucedida, deve-se realizar detalhado diagnóstico, avaliando de maneira específica as características dentárias e faciais, assim como as limitações impostas pela magnitude da discrepância. A queixa principal, as expectativas do paciente frente ao tratamento, os limites periodontais, padrão facial e controle vertical são alguns dos itens a serem explorados na determinação da viabilidade de um eventual tratamento compensatório. Os pacientes portadores de discrepância esquelética de Classe III associada a padrão facial vertical, hiperdivergente, com a presença ou tendência à mordida aberta anterior, merecem uma atenção especial. Nesses casos, uma eficiente estratégia de controle vertical deve ser planejada e instituída. OBJETIVO: o presente artigo tem como objetivo ilustrar a evolução de alternativas eficientes para controle vertical em pacientes hiperdivergentes - desde a utilização, em um passado recente, de dispositivos extrabucais na arcada inferior (J-hook), indo até os dias atuais, com o advento da ancoragem esquelética. Já para pacientes com um padrão facial mais equilibrado, a mecânica convencional com elásticos intermaxilares na direção de Classe III, associada à curva de Spee acentuada na arcada superior, reversa na inferior e elásticos verticais na região anterior, continua sendo uma excelente alternativa, desde que haja extrema colaboração na utilização dos elásticos.

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INTRODUCTION: Angle's Class III malocclusion is a dental discrepancy in a sagittal view that may appear or not with an important skeletal discrepancy. Facial esthetics may be affected by this skeletal discrepancy and it is one of the most common complaints of patients who seek orthodontic treatment. Class III treatment, in adults, may be done by compensatory tooth movement, in simple cases, or through an association between orthodontics and orthognathic surgery, in more severe cases. OBJECTIVE: This article describes a non-extraction compensatory Class III treatment case, applying the Tweed-Merrifield mechanical principles with headgear (J-Hook) in the mandibular arch. This case was presented at the V Brazilian Association of Orthodontics and Dentofacial Orthopedics (ABOR) Meeting, it was evaluated by members of Brazilian Board of Orthodontics and obtained third place in the general classification.

INTRODUÇÃO: a má oclusão de Classe III se caracteriza por uma desarmonia dentária anteroposterior, podendo estar ou não acompanhada por discrepâncias esqueléticas. A estética facial pode se apresentar comprometida, em maior ou menor grau, a depender da magnitude da discrepância, constituindo um dos principais fatores motivadores da procura por tratamento ortodôntico. O tratamento da Classe III em pacientes adultos pode ser realizado mediante compensação dentária, nos casos mais simples, ou, em situações mais severas, mediante a associação entre Ortodontia e Cirurgia Ortognática. OBJETIVO: o presente artigo objetiva relatar um caso clínico caracterizado por uma má oclusão de Classe III de Angle, tratado de forma compensatória, com extração dos terceiros molares inferiores, mediante a utilização de aparelhagem extrabucal na arcada inferior (J-hook), aplicando-se princípios da técnica de Tweed-Merrifield. Esse caso foi apresentado no 5º Congresso da Associação Brasileira de Ortodontia e Ortopedia Facial (ABOR), na categoria "mesa clínica", sendo avaliado por membros do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO) e obtendo o terceiro lugar na classificação geral.

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Class III malocclusion is characterized by anterior posterior dental disharmony, either with or without skeletal discrepancies. Facial esthetics may be compromised to a greater or lesser degree, depending on the magnitude of the discrepancy, and is one of the main factors motivating individuals to seek orthodontic treatment. In adult patients, therapy may be performed by means of dental compensation, in simpler cases, or in more severe situations, by means of association between Orthodontics and Orthognathic Surgery. The present article is a clinical case report of a patient with a vertical facial pattern, Angle Class III malocclusion, with open bite and important facial asymmetry. The patient was treated in a compensatory manner with extractions, using extra-oral appliances on the mandibular arch with high pull, applying the principles of the Tweed-Merrifield technique. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) as part of the requisites for becoming a BBO Diplomate.