RESUMEN
OBJECTIVES: To evaluate the impact of changes in upper incisor inclination and position on the alteration of the nasolabial angle (NLA) in a series of cases involving the extraction of four first premolars. MATERIALS AND METHODS: The study included 41 patients who underwent orthodontic treatment with premolar extractions. The patients were divided into two groups based on their pretreatment NLA values: Group 1 (NLA ≤ 100°) and Group 2 (NLA > 100°). Measurements of NLA, U1.NA and U1-NA were obtained before and after treatment and U1-Ls pretreatment measure was registered. Statistical analyses were performed to compare the differences in NLA, U1.NA and U1-NA between the two groups and to evaluate the influence of these variables added to U1-Ls (T1) on NLA changes. RESULTS: The results showed that Group 1 exhibited significant changes in NLA, while Group 2 did not. However, both groups showed significant changes in U1.NA and U1-NA. In Group 1, 80% of the individuals presented an increase in NLA and 20% no changes. In Group 2, 10% presented a decrease, 57% no changes and 33% an increase in NLA values. Multiple linear regression analysis indicated that the group factor had a statistically significant influence on NLA variation. Additionally, in Group 2, a negative correlation was observed between changes in U1.NA and NLA. CONCLUSIONS: The findings suggest that individuals with higher pretreatment NLA values tend to maintain their NLA values even after the correction of upper incisor inclination.
Asunto(s)
Diente Premolar , Incisivo , Extracción Dental , Humanos , Diente Premolar/cirugía , Femenino , Masculino , Adolescente , Cefalometría , Nariz/anatomía & histología , Maxilar , Niño , Toma de DecisionesRESUMEN
INTRODUCTION: This study aimed to evaluate the perception of facial attractiveness when nose and teeth, together or isolated, present different degrees of disharmony. The secondary objective was to compare the perception of laypersons with that of dentists. MATERIALS AND METHODS: This cross-sectional observational study included 112 individuals (58 laypersons and 54 dentists) that evaluated 6 manipulated images of the face of the same model, scoring their attractiveness using 10 cm Visual Analogue Scales (VAS), with least and most attractive at the left and right anchors, respectively. The images contained manipulations performed only on the nose (laterorhinia) and mouth (misaligned teeth), as follows: (1) standard photograph, with symmetrical nose + aligned teeth; (2) 2 mm nasal deviation + aligned teeth; (3) 4 mm nasal deviation + aligned teeth; (4) symmetrical nose + misaligned teeth; (5) 2 mm nasal deviation + misaligned teeth and (6) 4 mm nasal deviation + misaligned teeth. We used the repeated measures ANOVA test and Tukey's post-test for intra-group comparison of the images. The independent t-test was used for inter-group comparison of each image. RESULTS: In the laypersons' group, the highest grades were given to images with aligned teeth and the lowest to misaligned teeth (smallest mean difference = 2.88 cm). For this group, there was no statistically significant difference (P-values ranged from .988 to 1.000) between scores of the three images in which teeth were aligned (range of 7.70-7.78 cm). In the group of dentists, highest grades were given to images with aligned teeth and the lowest to misaligned teeth. Difference between images 3 and 4 was not statistically significant (P = .204). All other differences between any image of straight teeth and any image with misaligned teeth were significant and the smallest mean difference between the two groups of images was 1.87 (P = .039). However, in the images with aligned teeth, there was also a statistically significant difference with higher scores to the images with symmetrical nose in contrast with those with significant laterorhinia (mean difference = 1.03 cm). CONCLUSION: Teeth disharmonies had a more negative impact on the aesthetic perception of the face than did nose deviations, for both dentists and laypersons.
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Estética Dental , Maloclusión , Humanos , Estudios Transversales , Maloclusión/terapia , Nariz , Percepción , SonrisaRESUMEN
INTRODUCTION: Aggressive periodontitis causes periodontal destruction, with loss of supporting alveolar bone. The common symptom is rapid attachment loss in the first molar and incisor area, in young adults. OBJECTIVE: The aim of this study was to discuss the challenges, implications and the impact of orthodontic treatment in patients affected by severe periodontal problems, specifically aggressive periodontitis. DISCUSSION: In addition to other bacteria, the main pathogen involved in aggressive periodontitis is the Aggregatibacter actinomycetemcomitans. However, the susceptibility to the disease differs among individuals, being immune deficiencies the main reason for this variability. Many orthodontists are not comfortable about performing treatments on individuals with aggressive periodontitis. CONCLUSION: Orthodontic treatment is feasible in young patients with severe and localized aggressive periodontitis, as long as the limitations imposed by the disease are respected. An interdisciplinary approach is required, with frequent periodontal follow-up before, during and after orthodontic treatment, allowing the correction of dental positions without aggravating bone loss.
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Periodontitis Agresiva , Aggregatibacter actinomycetemcomitans , Periodontitis Agresiva/terapia , Humanos , Incisivo , Diente Molar , Adulto JovenRESUMEN
INTRODUCTION: Our objectives were to verify the impact of alterations in the vertical position of the maxillary canines in smile esthetic perceptions and to determine whether exposure of the gingival margins directly affects laypersons' and orthodontists' perceptions. METHODS: A smile photograph of a male subject showing gingival zeniths was selected, and the canine vertical positions were symmetrically modified in increments of 0.5 mm, creating 4 new images varying from 1.0 mm of intrusion to 1.0 mm of extrusion, with and without gingival exposure. The total of 10 images were evaluated by 60 orthodontists and 60 laypersons, who determined the level of attractiveness of each smile on a visual analog scale. RESULTS: For both orthodontists and laypersons, the canine vertical position modifications had a statistically significant influence (P <0.0001), and the gingival exposure had no significant influence on the smile esthetic evaluations. CONCLUSIONS: For both groups of evaluators, the most attractive smiles were the standard smile and the smiles with 0.5 mm of intrusion. The less attractive smiles were those with 1.0 mm of extrusion and 1.0 mm of intrusion. Orthodontists were more critical in their assessments. There were no differences in the esthetic evaluations of smiles with and without gingival margin exposure for both groups of evaluators.
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Diente Canino/anatomía & histología , Estética Dental , Ortodoncistas/psicología , Pacientes/psicología , Sonrisa , Humanos , FotograbarRESUMEN
Our objective was to report the orthodontic and surgical retreatment of a patient who had undergone a prolonged orthodontic treatment with extractions, but who had unsatisfactory results and persistent side effects. The man, aged 25 years 3 months, sought treatment with major complaints of facial and smile asymmetries. The clinical examination showed a mandibular deviation to the right and a maxillary occlusal cant. A Class II Division 1 subdivision right was observed. Radiographic examination showed extensive root resorptions in the maxillary second premolars and absence of the 4 first premolars. The maxillary midline was deflected 2 mm to the left, and the mandibular midline was shifted 5 mm to the right. Aligning and leveling were performed with orthodontic fixed appliances, with a standard edgewise system (0.022 × 0.028 in), followed by LeFort I maxillary impaction and bilateral sagittal split osteotomy with asymmetrical advancement. Retreatment showed outstanding results that remained stable after 3 years of follow-up. Root resorption in the second premolars did not seem to increase. Orthodontic-surgical intervention is the main choice for correcting esthetic and functional problems in facial asymmetry, particularly in cases of retreatment.
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Asimetría Facial/cirugía , Maloclusión Clase II de Angle/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Resorción Radicular/cirugía , Adulto , Asimetría Facial/complicaciones , Asimetría Facial/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Masculino , Maloclusión Clase II de Angle/complicaciones , Maloclusión Clase II de Angle/diagnóstico por imagen , Radiografía Dental , Radiografía Panorámica , Reoperación , Resorción Radicular/complicaciones , Resorción Radicular/diagnóstico por imagenRESUMEN
INTRODUCTION: In this study, we aimed to verify whether different levels of maxillary incisal edges influence the perception of smile attractiveness and whether gingival display affects this perception according to groups of orthodontists, dentists, orthodontic patients, and laypersons. METHODS: Photographs of the smiles of 1 man and 1 woman showing the gingival contours of the incisors and the canines were digitally altered, creating steps from 0 to 2.0 mm in 0.5-mm increments, with and without gingival exposure. The 20 pictures were shown in random order to 240 evaluators divided into 4 groups who were asked to provide attractiveness scores on visual analog scales. RESULTS: Both the steps (P <0.001) and the gingival exposure (P <0.05) had statistically significant influences on the evaluations in all groups. There was also a statistically significant difference (P <0.001) between the evaluations of orthodontists and the other groups, with distinct patterns. CONCLUSIONS: The most accepted vertical relationship of incisor borders was the 1.0-mm step. There were significant differences in the evaluation of orthodontists when compared with the other 3 groups, and no significant difference was detected between these groups. The gingival display altered significantly the esthetic perception of the smiles evaluated. There were significant differences between the evaluations of the smiles of the man and the woman.
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Estética Dental , Incisivo , Maxilar , Sonrisa , Adulto , Femenino , Encía , Humanos , MasculinoRESUMEN
It gives me great pleasure to interview Dr. Hyeon-Shik Hwang, an innovative orthodontist who has developed many creative techniques over his career. Dr. Hwang was born in Korea and received his DDS and PhD degrees from Yonsei University in Seoul. He is professor and chairman of the Department of Orthodontics at Chonnam National University School of Dentistry, Gwangju, Korea. Dr. Hwang, as a faculty at the university hospital, has maintained a successful clinical practice for more than 25 years. He has treated many adult patients focusing on esthetics and periodontal health and has developed many clinical techniques to improve the effectiveness and efficiency of treatment to the benefit of both the patient and practitioner. Dr. Hwang is also interested in the evaluation of facial asymmetry two- and three-dimensionally. As one of the early adopters of cone-beam volume imaging, he has given special emphasis on the management of surgical cases. He is married to Jung-Un Park with whom he has two sons. His favorite hobbies are photography and listening to music. When I was presented to him in a congress, it was a great pleasure meeting someone who I already admired for his singular work. Later on, his humbleness and knowledge made me marvel at him even more. I hope that all readers of Dental Press Journal of Orthodontics also enjoy the teachings from this brilliant Korean orthodontist! Guilherme Thiesen - interview coordinator.
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Enfermedades Periodontales , Estética Dental , República de CoreaRESUMEN
O objetivo deste estudo foi avaliar em testes de tração os efeitos na relação carga/deflexão de alças de retração em T quando alterados na confecção o tipo de liga metálica (aço inoxidável ou titânio-molibdênio -TMA) e a altura (7 e 9 mm). Quarenta alças foram confeccionadas combinando os dois fios e as duas alturas, divididas em 4 grupos (10 alças por grupo), mantendo-se uma dimensão horizontal de 10 mm. Os testes foram realizados em máquina para ensaios de tração com célula de carga, onde as alças de cada grupo sofreram ativações a partir de 1 mm até 3 milímetros, com intervalos de 0,5 mm. Os resultados mostraram que tanto a variação da liga quanto da altura da alça produziram variação significativa na relação carga/deflexão. Foi feita uma comparação entre os níveis de força encontrados em cada uma das situações testadas e os valores recomendados na literatura científica para retração dos dentes anteriores. Foi observado que para 1,0 mm de ativação, apenas as alças de aço com 7 mm de altura atingiram os níveis de força recomendados. Para as ativações de 1,5 e 2,0 mm, tanto as alças de aço de 9 mm quanto as alças de TMA com 7 mm atingiram tais valores. Para as ativações de 2,5 e 3,0 mm, apenas as alças de TMA com 9 mm de altura foram consideradas seguras, uma vez que todas as demais produziram forças demasiadamente altas para o uso clínico...
The aim of this study was to evaluate, in traction test, the effects on the load/deflection rate of the T-loop, when changing the type of alloy used in its confection (stainless steel-SS -or Titanium-Molybdenum alloy - TMA), and the height of the loop (7 and 9 millimeters). Forty loops were bent combining the two alloys and the two heights, divided in four groups of 10 loops each. The horizontal dimension was kept in 10 mm. The tests were made in a traction test machine with a load cell, where the loops from each group were activated from 1 to 3mm in steps of 0.5mm. Results showed that both the variation of the alloy and the variation of the height produce significant changes in the load/deflection rate. A comparison was made between the forces found in each of the situations tested and the numbers suggested in the scientific literature for anterior retraction, and it was observed that, for activations of 1mm, only the SS 7mm high loops reached the levels recommended. For activations of 1.5 and 2.0mm, both the loops made of SS 9mm high and the ones made of TMA 7mm high delivered the necessary force. For activations of 2.5 and 3.0 mm, only the TMA loops 9mm high were considered safe for clinical use, since all the other loops delivered excessive force...
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Humanos , Materiales Biocompatibles , Cierre del Espacio Ortodóncico , OrtodonciaRESUMEN
OBJECTIVE: The aim of this study was to review the reliability and reproducibility of 3D-CBCT (cone beam computed tomography) cephalometric landmark identification. METHODS: Electronic databases (Pubmed, Scopus, Web of Science) were searched for papers published from 1998 to October 2014. Specific strategies were developed for each database, with the guidance of a librarian. Two reviewers independently analyzed the titles and abstracts for inclusion. The articles that met the inclusion and exclusion criteria were selected for full-text reading, and the selected articles went through methodological quality evaluation. After the exclusion of repeated articles, the titles of the remaining ones were read and 1,328 of them were excluded. The abstracts of 173 articles were read, of which 43 were selected, read in full and submitted to the inclusion and exclusion criteria. Fourteen articles or studies with reliable methodology and reproducibility remained. The data were collected, organized into figures and analyzed for determination of the reliability and reproducibility of the three-dimensional cephalometric landmarks. RESULTS: Overall, the landmarks on the median sagittal line and dental landmarks had the highest reliability, while the landmarks on the condyle, porion and the orbitale presented lower levels of reliability. Point S must be marked in the multiplanar views associated with visualization in 3D reconstruction. Further studies are necessary for evaluating soft tissue landmarks.
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Puntos Anatómicos de Referencia/diagnóstico por imagen , Cefalometría/métodos , Tomografía Computarizada de Haz Cónico/métodos , Imagenología Tridimensional/métodos , Tomografía Computarizada de Haz Cónico/instrumentación , Humanos , Valores de Referencia , Reproducibilidad de los ResultadosRESUMEN
Objective : The aim of this study was to review the reliability and reproducibility of 3D-CBCT (cone beam computed tomography) cephalometric landmark identification. Methods : Electronic databases (Pubmed, Scopus, Web of Science) were searched for papers published from 1998 to October 2014. Specific strategies were developed for each database, with the guidance of a librarian. Two reviewers independently analyzed the titles and abstracts for inclusion. The articles that met the inclusion and exclusion criteria were selected for full-text reading, and the selected articles went through methodological quality evaluation. After the exclusion of repeated articles, the titles of the remaining ones were read and 1,328 of them were excluded. The abstracts of 173 articles were read, of which 43 were selected, read in full and submitted to the inclusion and exclusion criteria. Fourteen articles or studies with reliable methodology and reproducibility remained. The data were collected, organized into figures and analyzed for determination of the reliability and reproducibility of the three-dimensional cephalometric landmarks. Results : Overall, the landmarks on the median sagittal line and dental landmarks had the highest reliability, while the landmarks on the condyle, porion and the orbitale presented lower levels of reliability. Point S must be marked in the multiplanar views associated with visualization in 3D reconstruction. Further studies are necessary for evaluating soft tissue landmarks. .
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Servicios de Salud Comunitaria/organización & administración , Atención a la Salud/organización & administración , Cuidados a Largo Plazo , Servicios Comunitarios de Salud Mental/organización & administración , Trastornos Mentales/terapiaRESUMEN
OBJECTIVE: To evaluate the reliability of three-dimensional (3D) landmark identification in cone-beam computed tomography (CBCT) using two different visualization techniques. MATERIALS AND METHODS: Twelve CBCT images were randomly selected. Three observers independently repeated three times the identification of 30 landmarks using 3D reconstructions and 28 landmarks using multiplanar views. The values of the coordinates X, Y, and Z of each point were obtained and the intraclass correlation coefficient (ICC) was calculated. RESULTS: The ICC of the 3D visualization was rated >0.90 in 67.76% and 45.56%, and ≤0.45 in 13.33% and 14.46% of the intraobserver and interobserver assessments, respectively. The ICC of the multiplanar visualization was rated >0.90 in 82.16% and 78.56% and ≤0.45 in only 16.7% and 8.33% of the intraobserver and interobserver assessments, respectively. An individual landmark classification was done according to ICC values. CONCLUSIONS: The frequency of highly reliable values was greater for multiplanar than 3D reconstructions. Overall, lower reliability was found for points on the condyle and higher reliability for those on the midsagittal plane. Depending on the anatomic region, the observer must choose the most reliable type of image visualization.
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Puntos Anatómicos de Referencia/diagnóstico por imagen , Cefalometría/estadística & datos numéricos , Tomografía Computarizada de Haz Cónico/estadística & datos numéricos , Huesos Faciales/diagnóstico por imagen , Imagenología Tridimensional/estadística & datos numéricos , Adulto , Mentón/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico/métodos , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Procesamiento de Imagen Asistido por Computador/estadística & datos numéricos , Imagenología Tridimensional/métodos , Masculino , Mandíbula/diagnóstico por imagen , Cóndilo Mandibular/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Hueso Nasal/diagnóstico por imagen , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Interfaz Usuario-Computador , Adulto JovenRESUMEN
In this article, we report the orthodontic treatment of a boy (age 12 years 9 months) who had a midface deficiency, a concave facial profile with maxillary retrusion, a complete crossbite (anterior and posterior), and the maxillary right canine retained in the alveolus. Rapid maxillary expansion was performed followed by complete orthodontic treatment with fixed appliances combined with Class III elastics and anterior vertical elastics. Time was allowed to elapse until growth was virtually over before removing the fixed appliances (at age 18 years 4 months), and no retainer of any type was used. As a result of treatment, significant improvement was noted in his facial appearance, with a proper maxillomandibular relationship, total correction of the maxillary atresia, and satisfactory overjet and overbite. The results remained stable at the 4-year follow-up. Therefore, it can be argued that the use of Class III elastics combined with rapid maxillary expansion has a beneficial effect in the treatment of transverse and sagittal maxillary deficiency in growing patients. Excellence in how the treatment was finished and discontinuation of treatment and control in the final stages of growth contributed to the stability of the final results.
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Maloclusión de Angle Clase III/terapia , Ortodoncia Correctiva/métodos , Cefalometría/métodos , Niño , Diente Canino/patología , Diastema/terapia , Estudios de Seguimiento , Humanos , Masculino , Maxilar/anomalías , Maxilar/crecimiento & desarrollo , Respiración por la Boca/prevención & control , Diseño de Aparato Ortodóncico , Técnica de Expansión Palatina , Planificación de Atención al Paciente , Trastornos de la Articulación Temporomandibular/prevención & control , Técnicas de Movimiento Dental/instrumentación , Diente Impactado/terapiaRESUMEN
A correta determinação e manutenção da forma do arco dentário inferior durante o tratamento ortodôntico constitui-se em importante fator de estabilidade por manter o equilíbrio entre a harmonia facial, os aspectos funcionais, os componentes musculares envolvidos e entre dentes inferiores e as bases ósseas. Este estudo objetivou avaliar os métodos descritos na literatura, bem como propor e descrever uma maneira simples e rápida de determinação individualizada da forma e tamanho do arco dentário inferior. Utilizou-se descrição pormenorizada da técnica para a determinação individualizada da forma do arco inferior e consequente confecção e utilização dos arcos metálicos para as diversas etapas do tratamento ortodôntico. Consiste na concepção e utilização de um diagrama composto por 20 formas e tamanhos de arcos impressos em acetato transparente, que é sobreposto ao modelo de gesso inicial do paciente, onde são virtualmente localizados 5 pontos e é assim escolhida a forma e tamanho que reproduza o arco inferior com maior fidelidade. A proposta descrita como Diagrama Individualizado da Forma de Arco Mucha (DIFAM-UFF) é considerado rápido e fácil de ser aplicado, além de contemplar várias formas com diferentes tamanhos, ao passo que outros métodos requerem mais tempo ou utilizam apenas uma forma com diferentes tamanhos. A utilização clínica deste método por mais de duas décadas tem se mostrado extremamente útil e prática, não requerendo maiores dispêndios de cálculo ou tempo por parte do operador, além de constituir um importante fator para resultados de excelência. O diagrama proposto por Mucha (DIFAM- UFF) é um método simples, prático e abrangente para a determinação e manutenção da forma e tamanho do arco inferior nos procedimentos ortodônticos.
The proper establishment and maintenance of the lower dental arch form during orthodontic treatment is an important stability factor since it maintains balance among facial harmony, functional aspects, muscle components involved, as well as between lower teeth and bone base. This study aimed to evaluate the methods reported in the literature, and propose and describe a simple and fast way of individualized determination of the shape and size of the lower dental arch. It was used a detailed description of the technique for determining individual arch form and consequent construction and utilization of lower steel arches for the different stages of orthodontic treatment. It consists of the design and use of a diagram with 20 shapes and sizes of arches printed on a transparent acetate that is superimposed on the original plaster model of the patient. Then 5 points are virtually located, and thus the size and shape that best reproduce the lower arch with reliability are chosen. The method described as Muchas Arch Form Individualized Diagram (DIFAM-UFF) is considered fast and easy to apply, and contemplate various shapes with different sizes, while other methods use basically only one form with different sizes. For more than two decades the clinical use of this method has been extremely helpful and useful in determining and maintaining the shape and form of the lower arch. Since it is not time-consuming and does not require calculation it can be considered as an important factor to achieve excellent results. The diagram proposed by Mucha (DIFAM-UFF) is a simple and practical method for determining and maintaining the shape and size of the lower jaw in orthodontic procedures.
Asunto(s)
Arco Dental , OrtodonciaRESUMEN
OBJETIVO: este estudo clínico prospectivo avaliou as alterações dentoesqueléticas em pacientes portadores de más oclusões de Classe II esquelética e dentária, tratados com o aparelho ortopédico funcional Twin Block (TB). MÉTODOS: a amostra foi dividida em dois grupos de 19 indivíduos cada: o grupo TB, com idade média de 9 anos e 6 meses (d.p. = 10 meses); e o grupo controle, com idade média de 9 anos e 9 meses (d.p. = 13 meses), ambos situados na fase de pré-surto de crescimento puberal. O teste t de Student não paramétrico mostrou que a amostra era homogênea para os valores cefalométricos ao início do estudo. Radiografias cefalométricas ao início do estudo (T1) e ao final dos 12 meses (T2) foram obtidas de todos os pacientes. Os testes de Wilcoxon e Mann-Whitney foram utilizados para avaliar as mudanças intragrupos e intergrupos em T1 e T2. RESULTADOS: a relação molar de Classe I foi obtida em 15 indivíduos do grupo tratado, enquanto nenhuma modificação ocorreu no grupo controle. Não foram observadas alterações na maxila e no padrão vertical de crescimento facial. Um aumento significativo do comprimento total mandibular e um deslocamento anterior da mandíbula ocorreram no grupo tratado (p<0,05), assim como a redução do overjet, influenciado pela significativa retroinclinação do incisivo superior e vestibularização do incisivo inferior (p<0,05). CONCLUSÕES: o tratamento da Classe II em pacientes brasileiros apresentou efeitos esqueléticos e dentários, incluindo aumento do comprimento mandibular e compensação dos incisivos, respectivamente.
OBJECTIVES: This prospective clinical study evaluated dentoskeletal changes in Class II malocclusion patients after treatment with the Twin Block functional appliance. METHODS: The treatment group consisted of 19 subjects (mean age 9.5 years) and the control group consisted of 19 subjects (mean age 9.9 years) situated before the pubertal growth spurt. Unpaired Student's t test showed the sample homogeneity at the beginning of the study. Initial (T1) and one year follow-up (T2) cephalometric radiographs were obtained for all subjects. Wilcoxon test and Mann-Whitney test were used to evaluate changes intra and inter groups from T1 to T2. RESULTS: A Class I molar relationship was achieved in 15 subjects of the TB group while no modification occurred in the control group. No significant effect was observed either in the maxilla or in the vertical pattern. A significant increase in total mandibular length and an anterior displacement of the mandibular position occurred in the treated group (p<0.05) as well as an overjet reduction, influenced by significant upper incisor retroclination and lower incisor proclination (p<0.05). CONCLUSION: Class II treatment with the Twin Block appliance in Brazilian patients showed skeletal and dental effects, including increase in mandibular length and incisors compensation, respectively.
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Humanos , Niño , Aparatos Ortopédicos , Maloclusión Clase II de Angle , Huesos Faciales/crecimiento & desarrolloRESUMEN
PURPOSE: To evaluate the association of 3-dimensional changes in the position of the condyles, rami, and chin at splint removal and 1 year after mandibular advancement surgery. PATIENTS AND METHODS: This prospective observational study used preoperative and postoperative scans of 27 subjects presenting with a skeletal Class II jaw relationship with a normal or deep overbite. An automatic technique of cranial base superimposition was used to assess the positional and/or remodeling changes in the anatomic regions of interest. The displacements were visually displayed and quantified using 3-dimensional color maps. The positive and negative values of surface distances in the color maps indicated the direction of the displacements. Pearson correlation coefficients and a linear model for correlated data were used to evaluate the association between the regional displacements. RESULTS: The postoperative adaptations in the chin position between splint removal and 1 year after surgery were significantly negatively correlated with changes in the borders of the posterior ramus (left, r = -0.73, P ≤ .0001; and right, r = -0.68, P = .00) and the condyles (left, r = -0.53, P = .01; and right, r = -0.46, P = .02), indicating that these structures tended to be displaced in the same direction. Even though the mean condylar displacement with surgery was less than 1 mm, individual displacements greater than 2 mm with surgery were observed for 24% of the condyles. The condylar displacements were maintained at 1 year after surgery for 17% of the condyles. CONCLUSIONS: The surface distance displacements indicated that the postoperative adaptations at different anatomic regions were significantly related.
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Cefalometría/métodos , Imagenología Tridimensional/métodos , Mandíbula/anatomía & histología , Avance Mandibular/métodos , Adaptación Fisiológica/fisiología , Adulto , Mentón/anatomía & histología , Mentón/cirugía , Tomografía Computarizada de Haz Cónico/métodos , Oclusión Dental Céntrica , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Maloclusión Clase II de Angle/cirugía , Avance Mandibular/instrumentación , Cóndilo Mandibular/anatomía & histología , Osteotomía/métodos , Estudios Prospectivos , Base del Cráneo/anatomía & histología , Férulas (Fijadores)RESUMEN
OBJETIVO: avaliar através de imagens tridimensionais os deslocamentos dos ramos, côndilos e mento resultantes da cirurgia de avanço mandibular. MÉTODOS: este estudo prospectivo utilizou tomografias computadorizadas de feixe cônico das fases pré-cirúrgica e pós-cirúrgica de 27 indivíduos apresentando Classe II esquelética com padrão normocefálico ou braquicefálico. Uma técnica de superposição automatizada da base do crânio permitiu a avaliação de alterações esqueléticas em regiões anatômicas de interesse, e os deslocamentos foram visualizados e quantificados a partir da técnica dos mapas coloridos de superfícies. A estatística descritiva consistiu de valores médios, mínimo e máximo, e desvios-padrão. Mudanças maiores do que 2mm foram consideradas clinicamente relevantes e classificadas através de categorização dos valores. As tendências direcionais dos movimentos estruturais foram exibidas em valores positivos ou negativos. Coeficientes de correlação de Pearson foram aplicados com nível de significância de 95 por cento, testando se deslocamentos em determinadas regiões foram associados com outras áreas. RESULTADOS: o mento apresentou deslocamento anteroinferior médio de 6,81±3,2mm, enquanto a porção inferior dos ramos apresentou movimento lateral com a cirurgia (esquerdo = 2,97±2,71mm; direito = 2,34±2,35mm). Outras regiões anatômicas mostraram deslocamento médio menor que 2mm, mas com evidente variabilidade individual. Correlações estatisticamente significativas foram positivas e moderadas. Os côndilos, bordo posterior e porção superior dos ramos apresentaram correlação bilateral, enquanto as porções superior e inferior dos ramos mostraram correlação ipsilateral. CONCLUSÃO: o método 3D utilizado permitiu uma precisa visualização e quantificação dos resultados cirúrgicos, destacando-se o movimento anteroinferior do mento e o deslocamento lateral da porção inferior dos ramos mandibulares, mas com considerável variabilidade individual em todas as regiões anatômicas avaliadas.
OBJECTIVE: To evaluate changes in the position and remodeling of the mandibular rami, condyles and chin with mandibular advancement surgery through the superimposition of 3D Cone-Beam Computed Tomography (CBCT) models. METHODS: This prospective observational study used pre-surgery and post-surgery CBCT scans of 27 subjects presenting skeletal Class II with normal or horizontal growth pattern. An automatic technique of cranial base superimposition was used to assess positional and/or remodeling changes in anatomic regions of interest. Displacements were visually displayed and quantified by 3D color maps. Descriptive statistics consisted of mean values, standard deviations and minimum/maximum displacements. Changes greater than 2 mm were considered clinically relevant, and a categorization was done. Positive and negative displacements showed each region directional tendency. To test if displacements in anatomic regions were associated with each other, Pearson correlation coefficients were used under a 95 percent significance level. RESULTS: The chin moved anterior-inferiorly 6.81±3.2 mm on average and the inferior portion of the rami moved laterally (left: 2.97±2.71 mm; right: 2.34±2.35 mm). Other anatomic regions showed <2 mm mean displacements, but with evident individual variability. Significant statistical correlations were positive and moderate. The condyles, posterior border and superior portion of the rami showed a bilateral correlation, and the superior and inferior portion of the rami an ipsilateral correlation. CONCLUSION: This 3D method allowed clear visualization and quantification of surgery outcomes, with an anterior-inferior chin displacement and a lateral movement on the inferior portion of the rami, but with considerable individual variability in all the evaluated anatomic regions.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Simulación por Computador , Imagenología Tridimensional , Avance Mandibular , Ortodoncia , Cirugía Asistida por Computador , Cirugía Bucal , Tomografía Computarizada de Haz Cónico , Cráneo/anatomía & histología , Maloclusión Clase II de AngleRESUMEN
A erupção ectópica e a impacção de caninos superiores são achados relativamente comuns em Ortodontia e Odontopediatria. O diagnóstico e planejamento do tratamento normalmente envolve exames radiográficos complementares no intuito de avaliar o posicionamento dos caninos e o possível grau de reabsorção nos elementos adjacentes. Modelos virtuais tridimencionais gerados a partir de tomografia computadorizada podem ser úteis, já que geram informações precisas e intuitivas em relação à morfologia dentária e sua localização espacial. O objetivo deste relato de caso foi descrever como a utilização dessa tecnologia auxiliou no diagnóstico de reabsorção radicular decorrente da erupção ectópica de caninos superiores em gêmeos monozigóticos.