Practices and Perception of Paediatric Obstructive Sleep Apnea Among Orthodontists and Paediatric Dentists in Brazil: A Mixed-Methods Study Nathalia Carolina Fernandes Fagundes, Renata Travassos da Rosa Moreira Bastos, Arnaldo Perez, Carlos Flores‐Mir, David Normando Orthodontics and Craniofacial Research, 2026 ObjectivesTo explore orthodontists' (OTs) and paediatric dentists' (PDs) practices and perceptions regarding the screening and management of paediatric obstructive sleep apnea (OSA).MethodsThis explanatory sequential mixed methods design included OTs and PDs with active clinical practice in Brazil and encompassed a quantitative phase followed by a qualitative phase. In the quantitative phase, a survey assessing OSA screening and management practices was administered to OTs and PDs practicing in Brazil. Information‐rich OTs and PDs were interviewed in the qualitative phase. Descriptive statistics and the chi‐square test were used to analyse the survey data, while inductive content analysis was applied to the interview data. The results from both phases were integrated and reported narratively.ResultsThree hundred eighty‐one OTs and PDs completed the survey, and ten of them were interviewed. Nearly half of OTs and PDs administered sleep questionnaires and demonstrated some knowledge about paediatric OSA signs and symptoms. PDs and OTs primarily offered rapid maxillary expansion and functional mandibular advancement for managing selected children with OSA, with OTs being more frequently involved in this task than PDs. OTs and PDs identified several barriers and expressed the need for support regarding access to reliable screening tools and interprofessional care.ConclusionBrazilian OTs and PDs were aware of the main signs and symptoms of paediatric OSA and were somewhat involved in offering oral appliance management options. To further define the role of these professionals, increasing support for dental professionals in OSA management and updating existing clinical guidelines is warranted.
Efficacy of a simplified photobiomodulation protocol in orthodontic patients: a randomized crossover clinical trial Mylka Suellen de Moura Barros SANTOS, Renata Travassos da Rosa Moreira BASTOS, Nathália Carolina Fernandes FAGUNDES, David NORMANDO Dental Press Journal of Orthodontics, 2026 Introduction: Pain in orthodontic treatments results from an inflammatory process due to the application of forces. Despite photobiomodulation having shown effectiveness in reducing pain sensitivity, the method requires multiple sessions, which complicates its practical application in orthodontic clinics. Objective: To test a simplified protocol of photobiomodulation with a single application in adults undergoing orthodontic treatment. Material and methods: This single-blind, randomized, crossover study evaluated 30 participants undergoing fixed orthodontic treatment. Half of them received a single application of photobiomodulation, while the other half received a placebo, with group crossover after one month. The application was performed at 10 points using a GaAlAs diode laser (100 mW/cm2) immediately after appliance activation. Pain was assessed using a visual analog scale (VAS) at T0 (before the orthodontic check-up appointment), T24h (24 hours after the orthodontic control appointment), and T48h (48 hours after the orthodontic control appointment), and data were analyzed using two-way repeated measures ANOVA (time and intervention). Results: A total of 27 participants were evaluated. Pain was significantly higher at T24h than at T48h in both groups. Although there was no difference in pain sensitivity between the groups at T24h, pain significantly decreased in the intervention group after 48 hours. The variables of sex and age did not influence pain perception. Conclusion: The study shows that photobiomodulation can help control orthodontic pain, being well accepted by participants and not extending clinical time. However, the analgesic effects are still limited, indicating the need to refine the protocol to enhance its effectiveness.
Impact of Clear Aligners on the Temporomandibular Joint: A Systematic Review Lucca Sicilia, Giza Helen Nonato Miranda, Liana Fattori, Bruno D' Aurea Furquim, David Normando Orthodontics and Craniofacial Research, 2026 The temporomandibular joint (TMJ) may experience alterations during orthodontic treatments. Furthermore, gaps in the literature highlight a lack of robust evidence on the impact of clear aligner therapy (CAT) on the TMJ. This review aims to find the current evidence regarding the effects of CAT on the TMJ. Electronic searches were conducted in PubMed, Web of Science, Scopus, Embase, LILACS, The Cochrane Library and ProQuest Theses and Dissertations. The eligibility followed PECOS: Permanent‐dentition patients (P); CAT (E); CAT group baseline parameters (C); TMJ structural parameters (O). Data extraction included sample size, age, control group characteristics, assessed outcomes, evaluation tools and it periods and main results. Risk of bias was assessed with the Joanna Briggs Institute checklist and the ROBINS‐E tool. Certainty of evidence was determined using the GRADE approach. Of the 1490 references identified, only five met the eligibility criteria and were included. CAT was associated with dimensional alterations in the condyle volume and surface area, increased superior joint space and fossa depth and decreased condylar bone density. For condylar inclination or position, there are no significant changes. The certainty of evidence was low and very low, reasoned by studies design limitations and heterogeneity. Despite the lower number of studies and low evidence level, CAT seems to induce modest, predominantly increased changes in TMJ spaces and fossa depth, with insufficient clinical significance regarding if CAT effects on TMJ are positive or not. Future studies with standardised TMJ imaging are essential to establish more robust evidence. Trial Registration: PROSPERO CRD42024547484
Tooth wear and tertiary crowding: a 13-year cohort study in Amazon Indigenous populations Renata Travassos da Rosa Moreira Bastos, Eduardo Oliveira da Costa, David Normando Progress in Orthodontics, 2025 Background Tooth wear is an important mechanism for reducing dental dimensions and, consequently, dental crowding. The objective of this cohort study was to examine the relation of tooth wear, adjusted for covariates (age, tooth loss, arch perimeter and intercanine width), on tertiary crowding in Amazon Indigenous populations. Methods A sample of 40 Indigenous people in permanent dentition at T0 (baseline) and after 13 years (T1) were evaluated. The sample included 16 males and 24 females belonging to two villages, Arara (n = 22, mean ages 16.6 and 29.9 years) and Assurini do Xingu (n = 18, mean ages 16.0 and 29.6 years). Clinical, intraoral photograph and dental cast evaluations were performed at both times. The anterior crowding was measured using Little’s Irregularity Index (LI) and modeled through a multilevel linear regression with the predictor variables: village, tooth wear (T1-T0), age (T0), tooth loss (T1-T0), changes in intercanine width (T1-T0) and changes in arch perimeter (T1-T0). Results A slight increase was observed (< 1 mm) in anterior dental crowding and a decrease in arch perimeter < 1.5 mm, while tooth wear increased between 0.65 and 0.99 units. The contextual variable (village) had no significant association with LI. In the upper arch, tooth loss was the only variable that showed an inverse association with LI (β=-0.41, p < 0.05). In the lower arch, the increase in dental crowding was inversely associated with tooth wear (β=-1.30, p < 0.05) and changes in arch perimeter (β=-0.31, p < 0.05). The other variables did not show significant associations. Conclusion After 13 years, dental crowding and tooth wear increased, while the arch dimensions tended to decrease. The changes in long-term dental crowding seem to have distinct etiological components for each dental arch. In the mandible, the changes in incisor alignment were associated with increased tooth wear and decreased dental arch dimensions. Whereas in the maxilla, only tooth loss caused alterations in tooth alignment. It is suggested that the effect of increased tooth wear on the etiology of tertiary crowding is of small magnitude and restricted to the lower dental arch.
Precision wings treating skeletal class II in growing patients: a systematic review and meta-analysis Paulo Mecenas, Renata Travassos da Rosa Moreira Bastos, Nathalia Carolina Fernandes Fagundes, David Normando Progress in Orthodontics, 2025 Background Skeletal Class II malocclusion, often associated with mandibular deficiency, is commonly treated with functional appliances. Precision Wings are a functional appliance that provides an alternative approach by combining mandibular advancement with dental alignment. Objective This systematic review aimed to evaluate the effectiveness of Precision Wings in treating skeletal Class II malocclusion in growing patients. Eligibility criteria Studies assessing the correction of skeletal Class II malocclusion in growing patients treated with Precision Wings were selected according to the PICOS strategy. The PRISMA guidelines were followed. Information sources Unrestricted electronic searches were conducted across seven databases up to February 2025. Risk of bias and synthesis of results The ROBINS-I tool was used to assess the risk of bias (RoB) in non-randomized studies. A random-effects meta-analysis was performed, and the certainty of the evidence was evaluated using the GRADE approach. Results Seven studies were included, and data were extracted. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects meta-analysis. The findings suggest that Precision Wings may be effective in treating skeletal Class II malocclusion in growing patients through both dental and skeletal changes. Regarding skeletal effects, sagittal changes were limited to the mandible and were of small magnitude, with a reduction in ANB° (MD = -0.81; 95% CI: -1.04 to -0.58; p < 0.001) occurring exclusively due to an increase in SNB° (MD = 0.55; 95% CI: 0.11 to 0.98; p = 0.01), while no significant changes were observed in SNA° (MD = -0.02; 95% CI: -0.42 to 0.38; p = 0.91). The included studies did not report significant vertical effects. Meta-analyses comparing Precision Wings with other functional appliances were not feasible due to the small number of studies evaluating each comparison and the substantial clinical and methodological heterogeneity across the included studies. Conclusion Although the available scientific evidence on this topic is limited, treatment with Precision Wings appears to offer minimal clinical improvement in mandibular growth for the correction of skeletal Class II malocclusion. To obtain more conclusive findings, future research should prioritize well-structured randomized clinical trials with standardized treatment protocols, extended follow-ups, and consistent cephalometric assessment methods.
