RESUMEN

INTRODUCTION: The complete bilateral cleft lip and palate (BCLP) divides the maxillary arch into three segments, separated from each other, resulting in abnormal growth of the alveolar arch. This study evaluated the maxillary arch dimensions in BCLP and compared them with neonates without craniofacial anomalies. METHODS: This retrospective study was conducted in a tertiary cleft centre. Sixty-six neonates aged 0-5 months were divided into two groups: cleft group-children with BCLP (23 boys and 18 girls) and control group-children without craniofacial deformities (15 boys and 10 girls). The dental models were processed by a 3D scanner. Landmarks were marked to achieve inter-canine distance, inter-tuberosity distance and arch length measurements. t-Tests were used for intergroup comparisons (p < .05). RESULTS: The maxillary cleft arch was demonstrated to be wider and longer in the posterior region compared to the control group. The inter-canine distance did not present differences between the cleft and controls. The inter-canine distance of the control group was the only measurement influenced by the variable sex. CONCLUSIONS: The cleft significantly interfered with the arch posterior width and arch sagittal length, making them larger. There was no statistical difference in the measurements between sex in the cleft group.

Asunto(s)

Labio Leporino , Fisura del Paladar , Arco Dental , Maxilar , Humanos , Labio Leporino/patología , Labio Leporino/diagnóstico por imagen , Fisura del Paladar/patología , Fisura del Paladar/diagnóstico por imagen , Masculino , Femenino , Maxilar/patología , Maxilar/crecimiento & desarrollo , Estudios Retrospectivos , Arco Dental/patología , Arco Dental/diagnóstico por imagen , Lactante , Recién Nacido , Modelos Dentales , Imagenología Tridimensional/métodos , Cefalometría , Estudios de Casos y Controles , Puntos Anatómicos de Referencia/patología

RESUMEN

The oculoauriculofrontonasal syndrome (OAFNS) is a rare condition, with unknown etiology, characterized by the association of frontonasal dysplasia (FND) and oculoauriculovertebral spectrum (OAVS). Main clinical findings include widely spaced eyes, epibulbar dermoid, broad nose, mandibular hypoplasia, and preauricular tags. Here, we describe a case series of 32 Brazilian individuals with OAFNS and review the literature ascertaining individuals presenting phenotypes compatible with the diagnosis of OAFNS, aiming to refine the phenotype. This series emphasizes the phenotypic variability of the OAFNS and highlights the occurrence of rare craniofacial clefts as a part of the phenotype. The ectopic nasal bone, a hallmark of OAFNS, was frequent in our series, reinforcing the clinical diagnosis. The absence of recurrence, consanguinity, chromosomal, and genetic abnormalities reinforces the hypothesis of a nontraditional inheritance model. The phenotypic refinement provided by this series contributes to an investigation regarding the etiology of OAFNS.

Asunto(s)

Anomalías del Ojo , Síndrome de Goldenhar , Humanos , Oído Externo/anomalías , Anomalías del Ojo/diagnóstico , Anomalías del Ojo/genética , Columna Vertebral/anomalías , Síndrome de Goldenhar/diagnóstico , Fenotipo

RESUMEN

Objective: Individuals with syndromic craniosynostosis present alterations in the dental arches due to anomalies caused by the early fusion of the craniomaxillary sutures. This study aimed to compare intradental and interdental dimensions between individuals with Apert and Crouzon syndromes and nonsyndromic controls. Materials and Methods: Digital models were obtained from the archive of a public tertiary care hospital. The sample consisted of 34 patients (Apert n = 18, Crouzon n = 16) and 34 nonsyndromic controls matched for gender and age. Measurements of perimeter, length, intercanine and intermolar distances (upper and lower), overjet, and molar ratio were performed. Statistical comparisons were performed using ANOVA and Tukey tests (p < 0.05). Results: Patients with Apert and Crouzon syndromes have severely reduced maxillary transverse dimensions, perimeter, and length of the upper arch compared to the control group (p < 0.001). The lower arch is less impacted. Patients with Apert syndrome had an anterior crossbite (p < 0.001), while patients with Crouzon syndrome had an edge-to-edge bite (p < 0.011). Patients with Apert and Crouzon syndromes do not have serious transverse proportion problems when comparing the upper and lower arches. Conclusions: In this sample, both the Apert and Crouzon groups have severely compromised upper arches compared to the control group. Mild dentoalveolar expansion in the maxilla should be sufficient for the transverse adaptation of the dental arches before frontofacial advancement.

RESUMEN

OBJECTIVES: The objectives of this study were to characterize the craniofacial and airway morphology of oculo-auriculo-vertebral spectrum (OAVS) individuals using computed tomography (CT) examination. SETTING AND SAMPLE POPULATION: This sample included individuals in the age range from 5 to 14 years, consisted of a group of 18 OAVS individuals (12 females and 6 males), Pruzansky-Kaban1 IIB and III and by a paired control group matched by age and sex for comparison of morphometric and airway variables. MATERIALS AND METHODS: Through the CT examination, airway analysis was performed using Dolphin Imaging® Software, and seven morphometric measurements were performed to evaluate craniofacial morphology by Materialize Mimics® Software. To compare airway and morphometric variables, the control group was used. Student's t test and Mann-Whitney U test were performed to compare differences between the groups. RESULTS: Statistically significant differences were showed between the control and OAVS groups for the variables: total airway (TA) area, volume and MAA, RP area, RP volume, RP MAA, RG volume, RG MAA, total posterior height diff, Md incl and y-axis asymmetry. Pearson and Spearman's correlation showed mostly moderate correlations between Mand Occlusal canting AS with TA area and RP volume, Ax-Gn with TA area and Hy-C3 with TA volume. CONCLUSIONS: The OAVS's airway was altered and worse than the control group. Our results suggest that the contralateral side of OAVS individuals is unaffected; however, longitudinal assessments are needed to confirm it. Hyoid bone and postural measures play an important role in interpreting airway features of individuals with and without OAVS.

Asunto(s)

Síndrome de Goldenhar , Femenino , Síndrome de Goldenhar/diagnóstico por imagen , Humanos , Hueso Hioides/diagnóstico por imagen , Masculino , Tomografía Computarizada por Rayos X

RESUMEN

Congenital midline cervical cleft is a rare and generally isolated malformation of the ventral neck region with no clear etiology established. Mandibular deformities, such as micrognathia, could be considered as a consequence of a cleft cervical contracture. Complete surgical excision of the subcutaneous fibrous cord at an early age is the primary treatment modality, minimizing growth development problems on surrounding affected tissue. The aim of this study is to describe the clinical, surgical, and histological findings in a female child with congenital midline cervical cleft along with a relevant literature review. Three years follow-up after surgery exhibited satisfactory functional and cosmetic results.

Asunto(s)

Micrognatismo , Procedimientos de Cirugía Plástica , Niño , Femenino , Humanos , Mandíbula , Micrognatismo/cirugía , Cuello/cirugía

RESUMEN

OBJECTIVE: The aim of this study was to compare the dentoskeletal pattern of Treacher Collins syndrome (TCS) and nonsyndromic Pierre Robin sequence (PRS). DESIGN: Retrospective. SETTING: Single center. PATIENTS: Eighteen patients diagnosed with TCS (Group TCS) or PRS (Group PRS) in rehabilitation treatment at a single center. Group TCS was composed of 9 patients (4 male, 5 female) with a mean age of 12.9 years (standard deviation = 4.8). Group PRS was composed of 9 patients paired by age and sex with group TCS. MAIN OUTCOME MEASURE(S): Cone beam computed tomography-derived cephalometric images taken before the orthodontic or the orthodontic-surgical treatment were analyzed using Dolphin Imaging (Dolphin Imaging 11.0 & Management Solutions). Variables evaluating the cranial base, the maxillary and mandibular skeletal components, maxillomandibular relationship, the vertical components and the dentoalveolar region were measured. Intergroup comparisons were performed using t tests. The significance level considered was 5%. RESULTS: Intergroup differences in the mandible size and growth pattern were observed. Group TCS showed a smaller mandibular length (Co-Go, Co-Gn) and a higher palatal plane (SN-Palatal Plane) and mandibular plane angles (SN-Go.Gn) compared to group PRS. No differences between TCS and PRS were observed for the sagittal position of the maxilla, maxillomandibular relationship, and dental components. CONCLUSIONS: Treacher Collins syndrome presented a decreased mandible and a more severe vertical growth pattern compared to PRS.

Asunto(s)

Disostosis Mandibulofacial , Síndrome de Pierre Robin , Cefalometría , Femenino , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Disostosis Mandibulofacial/diagnóstico por imagen , Síndrome de Pierre Robin/diagnóstico por imagen , Estudios Retrospectivos

RESUMEN

OBJECTIVES: The purpose of this study was to evaluate the influence of a palatal splint on stability in multi-segment maxillary osteotomies. SETTING AND SAMPLE POPULATION: Retrospective series of fifty-one adult patients, consecutively operated with bilateral sagittal split osteotomy (BSSO) and three-piece maxillary osteotomies, divided according to the use of a palatal splint (Group 1, n = 30) or no palatal splint (Group 2, n = 21). MATERIALS AND METHODS: Maxillary surgical casts (T1) and post-retention casts (T2), taken at least six months after discontinuation of orthodontic retention, were digitized (MicroScribe-3DX), measured and compared. Fifty-one landmarks were identified on the maxillary, transverse dimension changes and arch length were calculated. Longitudinal changes in all measurements were assessed by t test. RESULTS: Post-surgical transverse instability in group 1 ranged from 0.3 ± 0.4 to -1.3 ± 0.2 mm and was statistically significantly smaller than in group 2 that ranged from -1.0 ± 0.3 to -2.5 ± 0.5 mm. CONCLUSIONS: The use of a palatal splint after segmental Le Fort I maxillary osteotomy improved transverse stability in the posterior region. The post-surgical transverse instability occurred only between canine gingival points and thus suggesting no clinical relevance.

Asunto(s)

Osteotomía Le Fort , Férulas (Fijadores) , Adulto , Cefalometría , Humanos , Maxilar/cirugía , Estudios Retrospectivos

RESUMEN

Este trabalho descreve o tratamento ortodôntico corretivo de uma adolescente do sexo feminino com fissura pré-forame incisivo completa. A paciente apresentava Padrão I, má oclusão de Classe I, presença de incisivo lateral superior supranumerário na região da fissura e apinhamento anterossuperior moderado. O reparo do lábio foi realizado aos 6 meses de idade. O defeito ósseo alveolar foi restabelecido por meio da cirurgia de enxerto ósseo alveolar secundário (EOAS) de origem autógena, aos 11,5 anos de idade. Houve boa formação de osso alveolar na região da fissura permitindo movimentação ortodôntica convencional nesta área 3 meses após o EOAS. O tratamento ortodôntico durou 2,5 anos. Foi alcançada oclusão satisfatória e estável. As radiografias finais indicaram aspecto saudável do periodonto na região de canino e incisivo lateral esquerdos. A paciente com fissura pré-forame incisivo apresenta algumas particularidades, como a ruptura da continuidade do rebordo ósseo alveolar, no entanto, o tratamento corretivo convencional pode ser realizado da maneira convencional após o procedimento de enxerto ósseo alveolar. (AU)

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This work describes the corrective orthodontic treatment of a female adolescent with alveolar cleft lip. The patient presented Class I skeletal pattern, Class I malocclusion, presence of a supernumerary lateral incisor at the cleft region, and moderate maxillary incisor crowding. Lip repair was executed at 6 months of age. The alveolar cleft was restored through secondary alveolar bone graft surgery (SABG) performed at 11.5 years of age using autogenous bone from the iliac crest. The successful alveolar bone filling permitted conventional orthodontic movement at the maxillary arch three months after SABG. Total orthodontic treatment time was 2.5 years. Adequate occlusion and aesthetic smile were achieved. Final radiographs showed normal aspect of periodontal bone at the left maxillary lateral incisor and canine region. The treatment of an alveolar cleft lip patient has some peculiarities, such as the disruption in continuity of the alveolar bone arch. However, the corrective orthodontic approach can be performed conventionally after the alveolar bone grafting procedure. (AU)

Asunto(s)

Humanos , Femenino , Adolescente , Labio Leporino , Ortodoncia , Ortodoncia Correctiva

RESUMEN

INTRODUCTION: This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods. METHODS: Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches. RESULTS: During orthodontic preparation, the maxillary and mandibular transverse dimensions measured at the premolar regions were increased and maintained throughout the follow-up period. Intercanine width was increased only in the upper arch during orthodontic preparation. Maxillary arch length was reduced during orthodontic finalization, only. Upper and lower arch depths were stable in the study periods. Differences between changes in centroid and gingival points suggested that upper and lower premolars buccaly proclined during the pre-surgical period. CONCLUSIONS: Maxillary and mandibular dental arches presented transverse expansion at premolar regions during preoperative orthodontic preparation, with a tendency towards buccal tipping. The transverse dimensions were not altered after surgery. No sagittal or vertical changes were observed during the follow-up periods.

Asunto(s)

Arco Dental/patología , Imagenología Tridimensional/métodos , Maloclusión Clase II de Angle/terapia , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Adolescente , Adulto , Puntos Anatómicos de Referencia/patología , Diente Premolar/patología , Cefalometría/métodos , Diente Canino/patología , Arco Dental/cirugía , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Maloclusión Clase II de Angle/cirugía , Mandíbula/patología , Mandíbula/cirugía , Maxilar/patología , Maxilar/cirugía , Modelos Dentales , Diente Molar/patología , Osteotomía Le Fort/métodos , Osteotomía Sagital de Rama Mandibular/métodos , Estudios Retrospectivos , Adulto Joven

RESUMEN

INTRODUCTION: This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods. METHODS: Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches. RESULTS: During orthodontic preparation, the maxillary and mandibular transverse dimensions measured at the premolar regions were increased and maintained throughout the follow-up period. Intercanine width was increased only in the upper arch during orthodontic preparation. Maxillary arch length was reduced during orthodontic finalization, only. Upper and lower arch depths were stable in the study periods. Differences between centroid and gingival changes suggested that upper and lower arch premolars buccaly proclined during the pre-surgical period. CONCLUSIONS: Maxillary and mandibular dental arches presented transverse expansion at premolar regions during preoperative orthodontic preparation, with a tendency towards buccal tipping. The transverse dimensions were not altered after surgery. No sagittal or vertical changes were observed during the follow-up periods. .

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INTRODUÇÃO: esse estudo avaliou as alterações tridimensionais ocorridas na morfologia das arcadas dentárias de pacientes submetidos ao tratamento ortodôntico-cirúrgico para a correção da má oclusão de Classe II, em três períodos distintos: (T1) modelos iniciais, (T2) modelos pré-cirúrgicos imediatos (de 1 a 15 dias antes da cirurgia) e (T3) modelos pós-cirúrgicos (mínimo de 6 meses após a remoção do aparelho ortodôntico). MÉTODOS: pontos previamente demarcados em cada modelo foram digitalizados por meio do digitalizador tridimensional MicroScribe-3DX, cujas coordenadas, armazenadas em planilhas do programa Excel, deram origem a valores que possibilitaram a avaliação da largura, comprimento e profundidade das arcadas dentárias. RESULTADOS: durante o preparo ortodôntico, houve aumentos nas distâncias transversais superiores e inferiores medidas na região de pré-molares que se mantiveram no período total de acompanhamento. Apenas a distância intercaninos superior apresentou alterações de aumento durante o preparo ortodôntico, assim como a largura da arcada superior, que diminuiu durante a fase de finalização. A profundidade de ambas as arcadas manteve-se estável nas fases avaliadas. Diferenças entre as mudanças dos pontos centroide e gengival sugerem que os pré-molares superiores e inferiores inclinaram para vestibular durante o preparo ortodôntico pré-cirúrgico. CONCLUSÇÕES: conclui-se que as arcadas dentárias superiores e inferiores sofreram expansão transversal na região de pré-molares durante o preparo ortodôntico pré-cirúrgico, com tendência à inclinação vestibular de todos os dentes posteriores. Após a cirurgia, as dimensões transversais ...

Asunto(s)

Adolescente , Adulto , Femenino , Humanos , Masculino , Adulto Joven , Arco Dental/patología , Imagenología Tridimensional/métodos , Maloclusión Clase II de Angle/terapia , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Puntos Anatómicos de Referencia/patología , Diente Premolar/patología , Cefalometría/métodos , Diente Canino/patología , Modelos Dentales , Arco Dental/cirugía , Estudios de Seguimiento , Procesamiento de Imagen Asistido por Computador/métodos , Maloclusión Clase II de Angle/cirugía , Mandíbula/patología , Mandíbula/cirugía , Maxilar/patología , Maxilar/cirugía , Diente Molar/patología , Osteotomía Le Fort/métodos , Osteotomía Sagital de Rama Mandibular/métodos , Estudios Retrospectivos

RESUMEN

A estabilidade do tratamento cirúrgico da classe III tem sido uma preocupação com relatos de pequenas ou significativas alterações mandibulares pós-cirúrgicas, Alguns pacientes afetados pela instabilidade do tratamento podem manter relação oclusal aceitável com compensações ortodônticas pós-cirúrgicas, mas outros irão desenvolver alterações oclusais e esqueléticas de forma significativa, necessitando de intervenção adicional ortodôntica e cirúrgica gerando custo adicional e aumento da morbidade. Muitas variáveis têm sido apontadas como preditoras da instabilidade do tratamento, mas poucos estudos sugerem a hiperplasia condilar (HC) como um fator de risco para a correção cirúrgica da Classe III. 51 pacientes classe III foram selecionados consecutivamente de uma população de pacientes operados entre 1996 e 2007 por um único cirurgião. Telerradiografias em norma lateral foram selecionadas nas seguintes fases: diagnóstico inicial, imediatamente antes da cirurgia, imediatamente após a cirurgia e com pelo menos um ano de acompanhamento pós-cirúrgico. Um total de 19 pontos de referência foram identificados e digitalizados através da utilização do software DFPlus (Dentofacial Software Inc, Toronto, Ontario, Canada). Estes pontos de referência foram utilizados para calcular 21 medidas lineares e/ou angulares e 10 medidas horizontais e verticais. A amostra que apresentava classe III associada a hiperplasia condilar obteve maior taxa de crescimento mandibular total pós puberal (2,6 mm) e maior comprimento do corpo (2,2 mm). Diante de uma má oclusão esquelética de classe III associada a HC, a adoção de uma abordagem de tratamento diferenciada é de fundamental importância para a obtenção de resultados estáveis, embora os tratamentos que envolvam a manipulação da articulação temporomandibular (ATM) sejam vistos com cautela por muitos profissionais da área de cirurgia, para algumas patologias articulares, como a hiperplasia condilar, é necessário a intervenção cirúrgica na ATM em conjunto com a cirurgia ortognática para que resultados previsíveis em longo prazo sejam obtidos, evitando assim uma segunda cirurgia para a correção definitiva do problema

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Class III surgical treatment stability has been a concern with reports of minor or significant post-surgical mandibular change. Most of the patients affected by treatment instability may retain acceptable oclusal relation while some of the skeletal position changes. Other affected patients have to undergo further treatment generating additional cost and increased morbidity. Many variables have been identified as predictors of treatment instability, but few reports suggest condylar hyperplasia as a risk factor for class III surgical correction. 51 class III patients records were consecutively selected from the patient population operated between 1996 and 2007 by the senior author. Lateral cephalometric radiographs were selected at the following periods: initial, immediate before surgery, immediate after surgery and at least one year follow-up). A total of 19 landmarks were identified and digitized using DFPlus software (Dentofacial Software Inc, Toronto, Ontario, Canada). These landmarks were used to compute 21 traditional linear and/or angular measurements and 10 horizontal and vertical measurements. During the observational period in the present sample condylar hyperplasia promoted higher post pubertal total mandibular growth rate (2.6 mm) and higher corpus length (2.2 mm). Appropriate condilar hyperplasia diagnosis and customized approach are mandatory in order to obtain stable results for Class III surgical treatment. Although treatments that involving manipulation of the temporomandibular joint to be viewed with caution by many professionals in the field of surgery, for some articular pathologies, such as condylar hyperplasia, it is necessary to approach the TMJ together with orthognathic surgery so that stable long term results are obtained, thereby avoiding a second surgery for the final remediationv of the problem

Asunto(s)

Humanos , Mandíbula/crecimiento & desarrollo , Cirugía Ortognática , Cóndilo Mandibular , Morbilidad , Maloclusión de Angle Clase III , Trastornos de la Articulación Temporomandibular

RESUMEN

INTRODUÇÃO: as discrepâncias entre o tamanho mesiodistal dos dentes superiores e inferiores e seus efeitos sobre a oclusão têm sido relatados há muito tempo. O método proposto por Bolton para o diagnóstico de discrepância de tamanho dentário é, inegavelmente, um dos mais difundidos no meio ortodôntico, devido à sua relativa simplicidade. Entretanto, a aplicação desse método requer cálculos matemáticos e o uso de tabelas que, muitas vezes, inviabilizam a sua utilização durante a avaliação clínica. OBJETIVO: avaliar o método proposto por Wolford, que não requer o uso de tabelas, como alternativa ao método tradicional de Bolton. MÉTODOS: a amostra foi composta por 90 pares de modelos dentários iniciais de pacientes adultos, com diferentes más oclusões. A proporção entre os dentes inferiores e superiores foi calculada para cada paciente, resultando na obtenção de dois índices (a razão total e a razão anterior). Os índices foram obtidos por meio do método originalmente proposto por Bolton e por um método alternativo, composto por duas fórmulas (uma simplificada e a variação da mesma), que foram analisadas separadamente. RESULTADOS: comparadas ao método de Bolton, as fórmulas simplificadas mostraram uma tendência de superestimar as discrepâncias dentárias inferiores (total e anterior), embora em pequena proporção. CONCLUSÕES: ambas as fórmulas do método alternativo podem ser utilizadas em substituição ao método tradicional, uma vez que mostraram diferenças médias menores que 0,58mm quando comparadas ao método de Bolton, não apresentando, portanto, significância clínica.

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INTRODUCTION: Mesiodistal size discrepancies of upper and lower teeth and their effect on occlusion have been related. Bolton's method for tooth size discrepancies is, undeniably, one of the most commonly-used methods in orthodontics because of its simplicity. However, the application of this method requires mathematical calculations and use of tables, which often prevents its clinical use. PURPOSE: Evaluate an alternative method for Bolton's analysis proposed by Wolford that does not require table information. MATERIAL AND METHODS: The sample was composed of 90 initial dental casts of adult patients, with different malocclusions. The ratio between the sum of widths of maxillary and mandibular teeth was calculated for each patient, resulting in the attainment of two indices: The overall ratio and the anterior ratio. Indices were calculated by Bolton's method and by an alternative method, using two different formulas (one simplified and a variation of the same formula) that were separately analyzed. RESULTS: In comparison with Bolton's method, the Simplified Formulas demonstrated a slight trend towards an overestimation of the inferior dental discrepancies (overall and anterior). CONCLUSION: Both formulas employed for the alternative method may be used to substitute the traditional method, since each demonstrated, on average, differences of less than 0.58 mm when compared with Bolton's method and no clinical significance.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Arco Dental , Diagnóstico Bucal , Maloclusión , Pesos y Medidas , Diente , Ortodoncia