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BACKGROUND: The purpose of this study was to evaluate the effectiveness of mandibular advancement devices (MADs) for treatment of obstructive sleep apnea syndrome (OSAS) compared with the results obtained with a placebo device in accordance with the following indicators: apnea hypopnea index (AHI) per hour of sleep, apnea index (AI) per hour of sleep, mean oxyhemoglobin saturation, sleep efficiency, and percentage of rapid eye movement (REM) sleep. METHODS: This is a controlled, prospective longitudinal study with a follow-up time of 10.5 months. Nineteen patients (8 females and 11 males) with mean age 48.6 years (SD 9.6) were selected for the study. The sample was randomized in terms of device use, and the evaluation design was double blind. A total of 57 polysomnography tests were studied (at baseline, after the use of a MAD, and after the use of placebo). The following variables were assessed: AHI, AI, mean oxyhemoglobin saturation, percentage of REM sleep, and sleep efficiency. Wilcoxon and Mann-Whitney tests were used for evaluating data (p<0.05). RESULTS: Reductions from 16.3 to 11.7 in AHI and from 5.7 to 3.8 in AI were observed after MAD use. During the use of placebo, AHI increased from 16.3 to 19.6, and AI from 5.7 to 7.5. The other indexes showed no statistically significant differences. CONCLUSIONS: Treatment with oral appliances, i.e., MADs, can be an effective alternative for mild and medium-to-moderate OSAS, but requires strict monitoring due to differences in individual response to this therapy.

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This case report refers to an 18-year-old female who suffered from dental trauma when she was 7 years old caused by a bicycle accident. Her maxillary right central incisor was avulsed, and the left one was extrusively luxated. The left central incisor was correctly repositioned and immobilized with a semi-rigid splint. The right one could not be found. She presented with class II malocclusion and severe negative arch-length discrepancies in both arches. The treatment objectives were the following: recover smile esthetics by replacing the maxillary right central incisor, correct the class II relationship, and optimally reduce mandibular and maxillary crowding. Extractions of the maxillary left lateral incisor and the lower right first bicuspid were performed; thus, the maxillary right lateral incisor would function as a maxillary right central incisor, the canines would function as lateral incisors, and the first bicuspids would function as canines. This allowed for the malocclusion to be corrected while simultaneously reestablishing the smile esthetics, without the use of an osseointegrated implant. A good occlusion with coincident upper and lower midlines was achieved. After orthodontic therapy, the patient underwent periodontal surgery to improve her gingival margins. Subsequent teeth bleaching was performed, and the patient received six porcelain veneers. A combination of orthodontic space closure and prosthetic rehabilitation may be the best treatment option after severe traumatic tooth loss.

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INTRODUCTION: In the last decade, an increasing number of studies focusing on the impact of oral deformities and illnesses on quality of life have been published. Our goal was to evaluate the impact of oral problems on quality of life in 3 groups of adult patients in need of orthognathic-surgical treatment. METHODS: A total of 117 patients were recruited from the Clinic of Oral and Maxillofacial Surgery of the State University of Rio de Janeiro in Brazil: 20 in the initial phase, 70 in the presurgical phase (presurgical orthodontic preparation), and 27 in the postsurgical phase. The impact of treatment phase on oral health-related quality of life was evaluated with the oral health impact profile (OHIP-14). OHIP-14 scores were calculated by an additive method, and the participants were divided on the basis of level of impact into 2 groups: high impact (scores, >11) and low impact (scores, < or =11). RESULTS: Compared with patients in the postsurgical phase, those who needed orthognathic surgical treatment but had not yet begun it and those who were in the presurgical phase of treatment were 6.48 and 3.14 times more likely, respectively, to experience a negative impact of their oral condition. CONCLUSIONS: Among those undergoing or anticipating orthognathic-surgical treatment, orthognathic surgery positively affects the patients' quality of life.

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INTRODUCTION: The aim of this study was to assess oral health-related quality of life (OHQOL) in adolescents who sought orthodontic treatment. A comparison between these adolescents and their age-matched peers who were not seeking orthodontic treatment provided an assessment of the role of OHQOL in treatment seeking. METHODS: The sample consisted of 225 subjects, 12 to 15 years of age; 101 had sought orthodontic treatment at a university clinic (orthodontic group), and 124, from a nearby public school, had never undergone or sought orthodontic treatment (comparison group). OHQOL was assessed with the Brazilian version of the short form of the oral health impact profile, and malocclusion severity was assessed with the index of orthodontic treatment need. RESULTS: Simple and multiple logistic regression analysis showed that those who sought orthodontic treatment reported worse OHQOL than did the subjects in the comparison group (P <0.001). They also had more severe malocclusions as shown by the index of orthodontic treatment need (P = 0.003) and greater esthetic impairment, both when analyzed professionally (P = 0.008) and by self-perception (P <0.0001). No sex differences were observed in quality of life impacts (P = 0.22). However, when the orthodontic group was separately evaluated, the girls reported significantly worse impacts (P = 0.05). After controlling for confounding (dental caries status, esthetic impairment, and malocclusion severity), those who sought orthodontic treatment were 3.1 times more likely to have worse OHQOL than those in the comparison group. CONCLUSIONS: Adolescents who sought orthodontic treatment had more severe malocclusions and esthetic impairments, and had worse OHQOL than those who did not seek orthodontic treatment, even though severely compromised esthetics was a better predictor of worse OHQOL than seeking orthodontic treatment.

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OBJECTIVES: To assess surgery and short-term post-surgery changes in the position of the condyles, rami and chin after mandibular advancement. METHODOLOGY: Pre-surgery (T1), 1 week post-surgery (T2), and 6 week post-surgery (T3) CBCT scans were acquired for 20 retrognathic patients with short or normal face height. 3D models were built and superimposed through a fully automated voxel-wise method using the cranial base of the pre-surgery scan as reference. Anatomic regions of interest were selected and analyzed separately. Within-subject surface distances between T1-T2, T2-T3, and T1-T3 were computed. Color-coded maps and semi-transparent display of overlaid structures allowed the evaluation of displacement directions. RESULTS: After an antero-inferior chin displacement with surgery in all cases (>4 mm in 87.5%), 25% of the patients showed some kind of posterior movement (< 3 mm), and 69% showed an antero-superior movement after splint removal. Comparing T1-T3, an antero-inferior (87.5% of the cases) or only inferior (12.5%) displacement was observed (>4 mm in 80%). Considering all directions of displacement, the surface distance differences for the condyles and rami were small: 77.5% of the condyles moved <2 mm with surgery (T1-T2), and 90% moved <2 mm in the short-term (T2-T3) and in the total evaluation (T1-T3), while the rami showed a <3 mm change with surgery in 72.5% of the cases, and a <2 mm change in 87.5% (T2-T3) and in 82% (T1-T3). CONCLUSIONS: Expected displacements with surgery were observed and post-surgery changes suggested a short-term adaptive response toward recovery of condyle and ramus displacements. The changes on the chin following splint removal suggested an acceptable adaptation, but with considerable individual variability.

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INTRODUCTION: Limitations of 2D quantitative and qualitative evaluation of surgical displacements can be overcome by CBCT and three-dimensional imaging tools. OBJECTIVES: The method described in this study allows the assessment of changes in the condyles, rami, chin, maxilla and dentition by the comparison of CBCT scans before and after orthognathic surgery. METHODS: 3D models are built and superimposed through a fully automated voxel-wise method using the pre-surgery cranial base as reference. It identifies and compares the grayscale of both three-dimensional structures, avoiding observer landmark identification. The distances between the anatomical surfaces pre and post-surgery are then computed for each pair of models in the same subject. The evaluation of displacement directions is visually done through color maps and semi-transparencies of the superimposed models. CONCLUSIONS: It can be concluded that this method, which uses free softwares and is mostly automated, shows advantages in the long-term evaluation of orthognathic patients when compared to conventional 2D methods. Accurate measurements can be acquired by images in real size and without anatomical superimpositions, and great 3D information is provided to clinicians and researchers.

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Obstructive sleep apnea and hipoapnea syndrome (OSAHS) is a disorder that affects about 4% of the adult population, and besides the social problems associated to snoring and extreme day time sleepiness, it is preoccupying since it may cause pulmonary hypertension and cardiac failure. REVIEW AND DISCUSSION: Through a literature review, we discuss the use of oral appliances to treat this condition, in regards of therapy effectiveness and limitations, main clinical symptoms, major occlusal side effects, rate of improvement and patient satisfaction. CONCLUSIONS: We concluded that the use of oral appliances should be a first choice treatment for mild to moderate OSAHS, being dental, joint and muscular discomforts, hypersalivation and xerostomia, the most frequent clinical symptoms, with light occlusal side effects that normally do not bother the patients, with a good degree of improvement and high satisfaction index.

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