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OBJECTIVE: This descriptive observational study aimed to determine clinically relevant and applicable data of enamel thickness (ETH), considering the mesio-distal differences of anterior and posterior permanent teeth and their relationships. MATERIAL AND METHODS: The sample consisted of right-sided standardized radiographs of 34 individuals (21 females and 13 males), aged between 13 and 24 (average 16) years, with all permanent teeth intact and without crowding. Four periapical and four interproximal radiographs were obtained and digitized. ETH measurements (mesial to distal contact points at the dentin-enamel junction) were performed after correction for radiographic image magnification. The Students' t-test was applied to the differences between paired means, with the Pearson correlation to evaluate the correlation between them. RESULTS: The mesial and distal ETH increased from the anterior to the posterior teeth. Incisor ETH ranged between 0.60 and 0.84 mm. Canines, premolars, and molars were more than 1.0 mm thick, and molar enamel reached values between 1.26 and 1.44 mm. CONCLUSION: Distal ETH was significantly greater than the mesial ETH, and progressively thicker from the anterior to posterior teeth. Interproximal reduction (IPR) of the lower central and upper lateral incisors should be avoided, reduced, or performed on their distal surfaces. There is a positive and significant correlation between ETH and the mesial and distal surfaces of the teeth. Periapical radiographs and evaluation of the remaining ETH are necessary in cases of retreatment. The location and number of tooth size discrepancies should be considered in treatment planning and appropriately compensated with IPR.
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Esmalte Dentário , Dentição Permanente , Humanos , Feminino , Esmalte Dentário/diagnóstico por imagem , Esmalte Dentário/anatomia & histologia , Masculino , Adolescente , Adulto Jovem , Dente Pré-Molar/diagnóstico por imagem , Dente Pré-Molar/anatomia & histologia , Dente Molar/diagnóstico por imagem , Dente Molar/anatomia & histologia , Incisivo/diagnóstico por imagem , Incisivo/anatomia & histologia , Dente Canino/diagnóstico por imagem , Dente Canino/anatomia & histologiaRESUMO
INTRODUCTION: An ideal orthodontic treatment involves qualitative and quantitative measurements of dental and skeletal components to evaluate patients' discrepancies, such as facial, occlusal, and functional characteristics. Deciding between orthodontics and orthognathic surgery remains challenging, especially in borderline patients. Advances in technology are aiding clinical decisions in orthodontics. The increasing availability of data and the era of big data enable the use of artificial intelligence to guide clinicians' diagnoses. This study aims to test the capacity of different machine learning (ML) models to predict whether orthognathic surgery or orthodontics treatment is required, using soft and hard tissue cephalometric values. METHODS: A total of 920 lateral radiographs from patients previously treated with either conventional orthodontics or in combination with orthognathic surgery were used, comprising n = 558 Class II and n = 362 Class III patients, respectively. Thirty-two measures were obtained from each cephalogram at the initial appointment. The subjects were randomly divided into training (n = 552), validation (n = 183), and test (n = 185) datasets, both as an entire sample and divided into Class II and Class III sub-groups. The extracted data were evaluated using 10 machine learning models and by a four-expert panel consisting of orthodontists (n = 2) and surgeons (n = 2). RESULTS: The combined prediction of 10 models showed top-ranked performance in the testing dataset for accuracy, F1-score, and AUC (entire sample: 0.707, 0.706, 0.791; Class II: 0.759, 0.758, 0.824; Class III: 0.822, 0.807, 0.89). CONCLUSIONS: The proposed combined 10 ML approach model accurately predicted the need for orthognathic surgery, showing better performance in Class III patients.
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Inteligência Artificial , Cefalometria , Aprendizado de Máquina , Procedimentos Cirúrgicos Ortognáticos , Humanos , Cefalometria/métodos , Feminino , Masculino , Má Oclusão Classe III de Angle/cirurgia , Má Oclusão Classe III de Angle/diagnóstico por imagem , Má Oclusão Classe II de Angle/cirurgia , Má Oclusão Classe II de Angle/diagnóstico por imagem , Adolescente , Adulto Jovem , Tomada de Decisão Clínica , Cirurgia Ortognática/métodos , AdultoRESUMO
ABSTRACT Objective: This descriptive observational study aimed to determine clinically relevant and applicable data of enamel thickness (ETH), considering the mesio-distal differences of anterior and posterior permanent teeth and their relationships. Material and Methods: The sample consisted of right-sided standardized radiographs of 34 individuals (21 females and 13 males), aged between 13 and 24 (average 16) years, with all permanent teeth intact and without crowding. Four periapical and four interproximal radiographs were obtained and digitized. ETH measurements (mesial to distal contact points at the dentin-enamel junction) were performed after correction for radiographic image magnification. The Students' t-test was applied to the differences between paired means, with the Pearson correlation to evaluate the correlation between them. Results: The mesial and distal ETH increased from the anterior to the posterior teeth. Incisor ETH ranged between 0.60 and 0.84 mm. Canines, premolars, and molars were more than 1.0 mm thick, and molar enamel reached values between 1.26 and 1.44 mm. Conclusion: Distal ETH was significantly greater than the mesial ETH, and progressively thicker from the anterior to posterior teeth. Interproximal reduction (IPR) of the lower central and upper lateral incisors should be avoided, reduced, or performed on their distal surfaces. There is a positive and significant correlation between ETH and the mesial and distal surfaces of the teeth. Periapical radiographs and evaluation of the remaining ETH are necessary in cases of retreatment. The location and number of tooth size discrepancies should be considered in treatment planning and appropriately compensated with IPR.
RESUMO Objetivo: Este estudo observacional descritivo teve como objetivo determinar dados clinicamente relevantes e aplicáveis da espessura do esmalte (EES), considerando as diferenças mésiodistais dos dentes anteriores e posteriores e suas relações. Material e Métodos: A amostra consistiu em radiografias periapicais padronizadas do lado direito de 34 indivíduos, 21 do sexo feminino e 13 do sexo masculino, com idade entre 13 e 24 anos (média = 16 anos), com todos os dentes permanentes íntegros e sem apinhamento. Quatro radiografias periapicais e quatro radiografias interproximais foram tiradas e digitalizadas. As medidas de EES (dos pontos de contato mesial e distal até a junção dentina-esmalte) foram realizadas após correção para adequar a ampliação da imagem radiográfica. Para as diferenças entre as médias pareadas, foi aplicado o teste t de Student com correlação de Pearson, para avaliar a correlação entre elas. Resultados: A EES mesial e distal aumenta dos dentes anteriores para os posteriores. A EES dos incisivos variou entre 0,6 e 0,84 mm. Caninos, pré-molares e molares apresentaram EES superior a 1,0 mm e a EES dos molares atingiu valores entre 1,26 e 1,44 mm. Conclusão: As EES distais são significativamente maiores que as mesiais e progressivamente mais espessas dos dentes anteriores para posteriores. A redução interproximal do esmalte (RIP) dos incisivos centrais inferiores e laterais superiores deve ser evitada, minimizada ou realizada em suas superfícies distais. Radiografias periapicais e avaliação da EES remanescente são necessárias nos casos de retratamento. A localização e o número de discrepâncias no tamanho dos dentes devem ser determinados e considerados no planejamento do tratamento, para que sejam adequadamente compensados durante o tratamento com RIP.
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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.
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Resumo A decisão pela extração de dentes permanentes para a solução de problemas ortodônticos considera, além da extração em si, outros fatores, dentre eles, as características clínicas do esmalte dos dentes a serem extraídos. O objetivo deste artigo foi apresentar como a presença de defeitos de esmalte dentário (DDE) influenciou na tomada de decisão e modificou o plano de tratamento ortodôntico proposto para o paciente. A severidade do defeito, o número de dentes afetados e a presença e complexidade de má oclusão são fatores que influenciaram na definição do plano de tratamento. Quanto mais grave os defeitos e mais complexa a má oclusão, maior a dificuldade no planejamento do tratamento e, em muitos casos, é indicado incorporar a contribuição de vários especialistas na tomada de decisões. Foi possível demonstrar que o tratamento da má oclusão associada a DDE com a exodontia dos dentes mais severamente afetados apresentou resultados estético e funcional adequados. Concluiu-se que um tratamento bem-sucedido da má oclusão com resultado estético dentofacial adequado, saudável e funcional, requer a compreensão da inter-relação entre os componentes estruturais bucais, oclusão dentária e estética facial.(AU)
Abstract The decision to extract permanent teeth to solve orthodontic problems considers, in addition to the extraction itself, other factors, and among them are the clinical characteristics of the enamel of the teeth to be extracted. The objective of this article was to present how the presence of dental enamel defects (DED) influenced decision-making and modified the proposed orthodontic treatment plan for the patient. The severity of the defect, the number of affected teeth and the presence and complexity of the malocclusion are factors that influenced the definition of the treatment plan. The more severe the defects and the more complex the malocclusion, the greater the difficulty in planning the treatment and, in many cases, it is indicated to incorporate the contribution of several specialists in the decision-making process. It was possible to demonstrate that the treatment of malocclusion associated with DED with the extraction of the most severely affected teeth, presented adequate aesthetic and functional results. It is concluded that a successful treatment of malocclusion with adequate, healthy, and functional dentofacial aesthetic results, requires understanding the interrelationship between oral structural components, dental occlusion and facial aesthetics. (AU)
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Humanos , Adolescente , Extração Dentária , Dentição Permanente , Esmalte Dentário , Índice de Necessidade de Tratamento OrtodônticoRESUMO
BACKGROUND: The Orofacial Esthetic Scale (OES) is an instrument to assess an individual's perception of their Orofacial Appearance (OA). However, its translation and evaluation of psychometric properties is necessary for its use in Brazilian individuals. OBJECTIVES: To develop the Portuguese version of OES (OES-Pt), estimate its psychometric properties (validity, measurement invariance and reliability) when applied to Brazilian individuals aged 18-40 years, and estimate the relationship between sociodemographic characteristics and OA. METHODS: This was a cross-sectional study using a convenience sample. The sample consisted of 1,072 Brazilian individuals (70.1% female, 25.1% dental patients; mean ± SD age: 25.7 ± 5.7 years). After cross-cultural adaptation of OES-Pt, factorial validity was evaluated by confirmatory factor analysis. Convergent validity (average variance extracted (AVE)) and reliability (Cronbach's alpha coefficient (α) and Composite Reliability (CR)) were also estimated. Concurrent validity was assessed (Pearson's correlational analysis (r) between OES-Pt total score and item eight of the OES which refers to global assessment of OA). Measurement invariance of the factorial model (multigroup analysis using ΔCFI) was evaluated for independent samples (sample randomly split into two: "Test Sample" and "Validation Sample" and according to sex: male and female, age range: 18-30 and 31-40 years, and whether the individual is undergoing dental treatment or not). A Structural Equation Model estimated the relationship between sociodemographic characteristics and OA. RESULTS: OES-Pt presented adequate fit to the sample. Convergent validity (AVE ≥ 0.56) and reliability (α and CR ≥ 0.89) were adequate. Concurrent validity was adequate (r = 0.88; p-value < 0.001). OES-Pt presented strict invariance for independent samples. Age, sex, and socioeconomic status (SES) were related to OA, indicated by standardized beta coefficients (standardized ß) of 0.036 (standard error: 0.007), 0.001 (0.094) and 0.196 (0.061), respectively on OA. These three relationships were either weak or not statistically significant. CONCLUSIONS: When measuring OA in Brazilian individuals, the OES-Pt was valid, reliable and invariant for independent samples. Age, sex and SES were weak or not statistically significantly related to OA.
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OBJECTIVES: To estimate the agreement between orthodontic pain perception, evaluated with the visual analog scale (VAS), and psychosocial and behavioural aspects of pain and to estimate the impact of clinical and demographic characteristics on these aspects. DESIGN: Cross-sectional design using non-probabilistic sampling. SETTING AND SAMPLE POPULATION: Orthodontic patients undergoing treatment at orthodontic clinics (n = 507 [63.3% women], mean age: 26.32 [SD = 11.70] years). MATERIALS AND METHODS: Psychosocial and behavioural aspects of pain were evaluated using the Multidimensional Pain Inventory (MPI-Orthodontic). Agreement between the pain impact level assessed according to different methods was estimated using the linear-weighted Kappa (κp ) statistic. Structural models were elaborated to estimate the impact of clinical and demographic characteristics on the psychosocial and behavioural aspects of pain. The fit of the model was evaluated, and the z test (α = 5%) was used to estimate the significance of the impact (ß). RESULTS: The agreement between VAS and MPI-Orthodontic factors was inadequate (κp = 0.028-0.584). The fit of the structural models was adequate. Women, younger individuals, and those who reported difficulty/pain with feeding exhibited greater perception of both the psychosocial and behavioural aspects. Individuals in lower socioeconomic strata who were not satisfied with treatment and did not seek treatment voluntarily exhibited greater perception of the psychosocial aspect of pain. CONCLUSIONS: The impact of orthodontic pain on psychosocial and behavioural aspects of patients' lives is a relevant issue. Clinical and demographic characteristics contributed to these aspects; however, pain intensity as a sole measure may be insufficient for an adequate understanding of pain perception.
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Percepção da Dor , Dor , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Medição da Dor , Escala Visual AnalógicaRESUMO
The objective of this research was to compare the effect single low-level laser therapy (LLLT) irradiation on pain perception in patients having fixed appliance treatment in the clinic of orthodontics. Sixty-two patients were recruited to participate in this randomized, double-blinded, placebo-controlled study. The patients were assigned to four groups: group I-laser on the right side; group II-placebo on the right side; group III-laser on the left side; group IV-placebo on the left. The laser or placebo was applied before separation, 24 and 48 h after separation of their first permanent molars in the lower arch. Just after the separation, the average of the pain for the placebo group was 1.6, significantly greater than the average of 1.1 registered for the laser group (p = 0.013). After 24 h and before the new irradiation, the values registered among the different groups did not show any differences. In relation to the gender, only after the first irradiation in placebo group, the female had a level of pain (0.1) significantly higher (p = 0.04) compared to male, and after 48 h, the group where the laser was applied had a difference (p = 0.04) among the gender with a value of lower pain for men (0.6) than for women (1.6).The laser irradiation to minimize the pain was only effective when applied immediately after treatment and separation. In general way, there were no differences between the genders, except after the first placebo group irradiation in which the female had a significantly higher level of pain compared to male and after 48 h. The pain cycle observed in this study had its peak in 24 h, both for laser's and placebo's group.
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Terapia com Luz de Baixa Intensidade , Ortodontia , Dor/cirurgia , Método Duplo-Cego , Feminino , Humanos , Masculino , Aparelhos Ortodônticos Fixos , Medição da Dor , Percepção da Dor , Adulto JovemRESUMO
The aim of this study was to evaluate enamel roughness, quality of the enamel surfaces and time duration comparing different orthodontic adhesive removal protocols. Premolars were used to test three adhesive removal methods (n = 20): five-blade carbide bur, 30-blade carbide bur, and ultrasonic diamond bur. Bracket was bonded using TransbondTM XT adhesive. Roughness with different parameters was measured before bracket bonding and after adhesive remnants removal. Micromorphological analysis of enamel surface (n = 5) was performed by SEM images and categorized in enamel damage index-"perfect"; "satisfying"; "imperfect"; and "unacceptable". Time was measured in seconds. All removal methods caused increased roughness in relation to Ra, Rq, and Rz parameters (X axis) comparing to healthy enamel surface. Enamel surface resulted from removal using five-blade burs was scored as satisfactory. Carbide bur groups decreased the roughness values of Ra, Rq, and Rz parameters on the Y axis and enamel surface was considered unacceptable. The 30-blade group increased symmetry (Rsk) and flattening (Rku) parameters of roughness and surface was scored as unsatisfactory. Diamond bur removed adhesive in 54.8 s, faster than five-blade carbide bur. The five-blade bur group resulted in less enamel roughness than the 30-blade and diamond groups.
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The aim of this study was to evaluate dental and skeletal changes induced by the use of Herbst appliance compared to natural growth in young adults with Class II division I malocclusion with mandibular retrusion, by means of lateral oblique radiographs. Forty-six subjects, I4 -18 years old, after pubertal growth peak, with Class II division I malocclusion were assessed. Subjects were divided into two groups: the Experimental group included 23 subjects treated with Metallic Splinted Herbst and the Control group included 23 subjects followed without treatment. The Experimental and Control groups were paired by sex and chronological age. Oblique lateral cephalometric radiographs of the left and the right side of the mandible before treatment (TI) and after 8 months' treatment (T2) were used to evaluate dental and skeletal changes. Statistical analysis was performed with Intra Class Correlation and Student t-test, according to the study hypothesis. The results showed that the appliance corrected the Class II relationship in an 8-month period by mesial tipping movement of lower permanent first molars. It had little influence on mandibular structure and mandibular length and no influence on maxillary structure and upper molar. To conclude, late treatment of Class II malocclusion with the Herbst appliance was accomplished by means of dentoalveolar changes. These findings suggest that this type of treatment can be used in patients after growth has ceased because the results do not depend upon skeletal changes.
O objetivo é avaliar mudanzas dento esqueléticas induzidas pelo uso do aparelho de Herbst considerando crescimento natural através da telerradiografía cefalométrica em 45o em adultos jovens com Classe II divisao 1 e retrusao mandibular. Uma amostra de 46 individuos com idade entre 14 a 18 anos, após surto de crescimentopubertário, Classe II divisao 1 foram avaliados e divididos em dois grupos: grupo Experimental, 23 individuos que foram tratados com Herbst splint metálico e grupo Controle, 23 individuos que foram acompanhados sem tratamento. Os grupos experimental e Controle foram pareados por genero e idade cronológica. Foram usadas telerradiografias cefalométrica em 45o dos lados esquerdo e direito da mandíbula antes do tratamento (T1) e após periodo de 8 meses de tratamento e seguinte (T2) para avaliar as mudanzas dento esqueléticas. Análise estatistica foi realizada com o indice de Correlagao Intra Classe e teste t de Student de acordo com a hipótese do estudo. Os resultados mostraram que houve corregaoda relagao de Classe II no periodo de 8 meses por movimento mesial do primeiro molar inferior. O aparelho teve pequena influencia na estrutura mandibular e compri-mento mandibular e nenhuma influencia na estrutura maxilar e molar superior. Em conclusao, o tratamento tardio da má-oclusao de Classe II com o aparelho MESPHER foi alcangado através de mudangas dento alveolares.
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Cefalometria , Má Oclusão Classe II de Angle/terapia , Mandíbula/anatomia & histologia , Mandíbula/crescimento & desenvolvimento , Aparelhos Ortodônticos Funcionais , Adolescente , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVE: The aim of this study was to perform a systematic review on the morphological characteristics of the skull base (flexion, anterior length and posterior length) and the concomitant development of malocclusions, by comparing differences in dimorphism, ethnicity and age. METHODS: The articles were selected by means of electronic search on BBO, MEDLINE and LILACS databases from 1966 to 2016. A qualitative evaluation of the methodologies used on the articles was also performed. RESULTS: Although the literature on this topic is abundant, only 16 articles were selected for the present systematic review. The cranial base angle itself does not seem to play a significant role in the development of malocclusions. In fact, the cranial base angle is relatively stable at the ages of 5 to 15 years. CONCLUSIONS: A more obtuse angle at the skull base, in association or not with a greater anterior length of the cranial base, can contribute to the development of Class II division 1 malocclusions. On the other hand, a more acute angle at the skull base can contribute to a more anterior positioning of the mandible and to the development of Class III malocclusions.
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Má Oclusão/patologia , Base do Crânio/patologia , Cefalometria , HumanosRESUMO
ABSTRACT Objective: The aim of this study was to perform a systematic review on the morphological characteristics of the skull base (flexion, anterior length and posterior length) and the concomitant development of malocclusions, by comparing differences in dimorphism, ethnicity and age. Methods: The articles were selected by means of electronic search on BBO, MEDLINE and LILACS databases from 1966 to 2016. A qualitative evaluation of the methodologies used on the articles was also performed. Results: Although the literature on this topic is abundant, only 16 articles were selected for the present systematic review. The cranial base angle itself does not seem to play a significant role in the development of malocclusions. In fact, the cranial base angle is relatively stable at the ages of 5 to 15 years. Conclusions: A more obtuse angle at the skull base, in association or not with a greater anterior length of the cranial base, can contribute to the development of Class II division 1 malocclusions. On the other hand, a more acute angle at the skull base can contribute to a more anterior positioning of the mandible and to the development of Class III malocclusions.
RESUMO Objetivo: o objetivo desse estudo foi realizar uma revisão sistemática sobre as características morfológicas da base do crânio (flexão, comprimento anterior e comprimento posterior) e o desenvolvimento concomitante da má oclusão, comparando as diferenças do dimorfismo, etnia e idade. Métodos: os artigos foram selecionados por meio de busca eletrônica nas bases de dados BBO, MEDLINE e LILACS, de 1966 a 2016. Uma avaliação qualitativa da metodologia dos artigos também foi executada. Resultados: ainda que a literatura seja abundante nesse assunto, somente 16 artigos foram selecionados para a presente revisão sistemática. O ângulo da base do crânio, por si só, não parece desempenhar papel significativo no desenvolvimento das más oclusões. De fato, o ângulo da base do crânio é relativamente estável dos 5 aos 15 anos. Conclusões: um ângulo mais obtuso na base do crânio, associado ou não a um comprimento maior, pode contribuir para o desenvolvimento da má oclusão de Classe II, divisão 1. Por outro lado, um ângulo mais agudo na base do crânio pode contribuir para um posicionamento mais anterior da mandíbula e para o desenvolvimento da má oclusão de Classe III.
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Humanos , Base do Crânio/patologia , Má Oclusão/patologia , CefalometriaRESUMO
BACKGROUND: This study aimed to evaluate three-dimensional changes in mandibular position after surgically assisted rapid maxillary expansion (SARME). METHODS: A retrospective study was carried out with tomographic records of 30 adult patients with maxillary transverse deficiency who underwent SARME. Cone beam computed tomography scans were obtained preoperatively (T1), after expansion (T2) and 6 months after expansion (T3). Mandibular landmarks were measured with respect to axial, sagittal, and coronal planes. Repeated measures ANOVA was used for statistical analysis. RESULTS: Clockwise rotation and lateral displacement of the mandible were observed immediately after SARME. However, mandibular displacements tended to return close to their initial values at T3. CONCLUSIONS: Clockwise rotation and lateral shift of the mandible are transient effects of SARME.
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Mandíbula/anatomia & histologia , Técnica de Expansão Palatina , Adolescente , Adulto , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
O sucesso do tratamento de pacientes com agenesia de incisivo inferior depende dos fatores dentários, esqueléticos e faciais associados. No planejamento considerações estéticas e funcionais são importantes para a escolha da forma de tratamento mais apropriado, quer seja a adequação da oclusão dentária ou a reabilitação protética do espaço deixado pela ausência. Esse artigo tem como objetivo descrever duas formas de abordagem para correção dos vários aspectos decorrentes da agenesia de um incisivo inferior. Pode-se concluir que a agenesia de incisivos inferiores pode comprometer a oclusão dentária, o desenvolvimento alveolar anterior inferior, a região de sínfise mandibular, a estética facial e o equilíbrio funcional lábio-lingual. O diagnóstico precoce e planejamento adequado do tratamento envolvendo equipe multidisciplinar podem produzir resultados favoráveis, evitando o impacto negativo da ausência congênita na qualidade de vida da criança pela redução dos sintomas bucais e limitação funcional, promovendo seu bem-estar emocional e social.( AU)
Treatment success of patients with lower incisor agenesis depends on associated dental, skeletal and facial factors. When planning, aesthetic and functional considerations are important for choosing the most appropriate form of treatment, whether it is the adequacy of dental occlusion or the prosthetic rehabilitation of the space left by the absence. This article aims to describe two approaches to correct the various aspects resulting from the lower incisor agenesis. We can conclude that agenesis of lower incisors may compromise dental occlusion, lower anterior alveolar development, mandibular symphysis region, facial aesthetics and lip-tongue functional balance. Early diagnosis and adequate treatment planning involving a multidisciplinary team can produce favorable results, avoiding the negative impact of congenital absence on the child's quality of life through reduction of oral symptoms and functional limitation, promoting his/her emotional and social well-being.. (AU)
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Humanos , Masculino , Feminino , Criança , Adolescente , Anodontia , Incisivo , Ortodontia CorretivaRESUMO
The aim of this article is to describe a case report of Class III malocclusion treatment with lower first molar extraction. The 27-year-old Caucasian male patient presented a symmetric face with a straight profile, hyperdivergent growth pattern, molar and cuspid Class III relation, and an anterior crossbite as well as a mild crowding on cuspids area, in both upper and lower arches and a tendency to posterior crossbite. The treatment was performed by the use of Haas expansion appliance followed by an initial alignment and leveling of the upper and lower arches with a fixed edgewise appliance, extraction of lower teeth aiming the correction of the incisors proclination and end the treatment with a Class I molar relationship. It resulted in a significant change in the patient's profile, dentoalveolar Class III correction, upper arch expansion, leveling and alignment of the upper and lower arches, and improvement of tipping of the upper and lowers incisors. In cases of a dentoalveolar compensation in well positioned bone bases the treatment with fixed appliances is an alternative and extraction of lower teeth is considered.
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Surgical procedure for removal of impacted teeth is a challenge for clinicians as it involves accuracy in the diagnosis and localization of the dental elements. The cone-beam computed tomography (CBCT), compared to the conventional radiography, has a greater potential to provide complementary information because of its three-dimensional (3D) images, reducing the possibility of failures in surgical procedures. Two 10-year-old boys presented with aesthetic issues associated with the juxtaposition of ectopic teeth with the permanent ones. Both two-dimensional and 3D preoperative radiographic diagnostic sets were produced. The occlusal and panoramic radiographs were not enough for proper localization of impacted incisors. Thus, the CBCT was used as a surgical guide. After 2 years of longitudinal following, no lesion was recorded, and the orthodontic treatment has proven successful. In all cases, CBCT contributed to both diagnosis and correct localization of supernumerary teeth, aiding the professional in the treatment planning, and consequently in the clinical success. The surgeries were completely safe, avoiding damage in noble structures, and providing a better recovering of the patients.
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Resumen Introducción y objetivo: Las medidas y análisis de modelos son esenciales para el diagnóstico de casos de ortodoncia. Actualmente, el análisis de modelos puede ser realizado de manera virtual a través de software de computador como el o3d. El objetivo de este estudio fue evaluar la reproductibilidad, confiabilidad y validez de medidas dentales y transversales en modelos digitales usando el software o3d y compararlas con las medidas obtenidas con el calibrador digital en modelos de yeso. Materiales y métodos: Treinta pares de modelos fueron escaneados y digitalizados. Dos examinadores midieron el tamaño dentario, distancia intercanina y distancia intermolar en modelos de yeso usando un calibrador digital y en modelos digitales usando el software o3d. Los datos fueron analizados usando el Coeficiente de Correlación Intraclase, prueba t pareada, la fórmula de Dahlberg y el análisis de varianza. Resultados: Excelente reproductibilidad intra e interexaminador fue observada en las medidas realizadas con el calibrador digital y el software o3d. No se presentaron errores aleatorios con ninguno de los dos métodos y el error sistemático fue más frecuente en los modelos digitales. Conclusión: El software o3d presentó un buen desempeño en términos de reproductibilidad, confiabilidad y validez en la medición del tamaño dentario y distancias transversales; aunque los métodos presentaron diferencias estadísticas, la magnitud de esa diferencia es clínicamente irrelevante.
Abstract Introduction and objetive: Measurements and analyses of dental casts are essential for precise diagnosis of an orthodontic case. At present, analyses of dental casts can be performed virtually, through computer software as o3d. The aim of this study was to evaluate the reproducibility, reliability and validity of measurements made in digital models using the o3d software compared to plaster models. Materials and methods: Thirty pair of plaster casts were scanned and digitized. Two examiners measured tooth size, intercanine distance and intermolar distance in a plaster model with a digital caliper and in a digital model using the o3d software system. The data were statistically analyzed by Intraclass Correlation Coefficient test, paired samples t test, Dahlberg's formula and analysis of variance. Results: Excellent intraexaminer and interexaminer agreement was observed in the measurments performed with digital caliper and o3d software. No random error was present in the measurements obtained with the digital caliper and o3d software; systematic error was more frequent in the digital casts. Conclusion: The o3d software presented a good performance in terms of reproducibility, reliability and validity in measuring tooth size and transverse distance. Although measurements made on plaster and digital models showed statistically significant differences, the magnitude of the differences does not appear to be clinically relevant.
RESUMO
INTRODUCTION: Lateral cephalometric radiographs are traditionally required for orthodontic treatment, yet rarely used to assess asymmetries. OBJECTIVE: The objective of the present study was to use lateral cephalometric radiographs to identify existing skeletal and dentoalveolar morphological alterations in Class II subdivision and to compare them with the existing morphology in Class I and II relationship. MATERIAL AND METHODS: Ninety initial lateral cephalometric radiographs of male and female Brazilian children aged between 12 to 15 years old were randomly and proportionally divided into three groups: Group 1 (Class I), Group 2 (Class II) and Group 3 (Class II subdivision). Analysis of lateral cephalometric radiographs included angular measurements, horizontal linear measurements and two indexes of asymmetry that were prepared for this study. RESULTS: In accordance with an Index of Dental Asymmetry (IDA), greater mandibular dental asymmetry was identified in Group 3. An Index of Mandibular Asymmetry (IMA) revealed less skeletal and dental mandibular asymmetry in Group 2, greater skeletal mandibular asymmetry in Group 1, and greater mandibular dental asymmetry in Group 3. CONCLUSION: Both IDA and IMA revealed greater mandibular dental asymmetry for Group 3 in comparison to Groups 1 and 2. These results are in accordance with those found by other diagnostic methods, showing that lateral cephalometric radiography is an acceptable method to identify existing skeletal and dentoalveolar morphological alterations in malocclusions.
Assuntos
Cefalometria/métodos , Assimetria Facial/diagnóstico por imagem , Má Oclusão Classe II de Angle/diagnóstico por imagem , Má Oclusão Classe I de Angle/diagnóstico por imagem , Adolescente , Processo Alveolar/diagnóstico por imagem , Criança , Queixo/diagnóstico por imagem , Arco Dental/diagnóstico por imagem , Assimetria Facial/classificação , Ossos Faciais/diagnóstico por imagem , Feminino , Humanos , Incisivo/diagnóstico por imagem , Masculino , Má Oclusão Classe II de Angle/classificação , Mandíbula/diagnóstico por imagem , Maxila/diagnóstico por imagem , Dente Molar/diagnóstico por imagem , Osso Nasal/diagnóstico por imagem , Palato/diagnóstico por imagem , Radiografia , Retrognatismo/classificação , Retrognatismo/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagemRESUMO
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.
Assuntos
Arco Dental/patologia , Imageamento Tridimensional/métodos , Má Oclusão Classe II de Angle/terapia , Ortodontia Corretiva/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Adolescente , Adulto , Pontos de Referência Anatômicos/patologia , Dente Pré-Molar/patologia , Cefalometria/métodos , Dente Canino/patologia , Arco Dental/cirurgia , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Má Oclusão Classe II de Angle/cirurgia , Mandíbula/patologia , Mandíbula/cirurgia , Maxila/patologia , Maxila/cirurgia , Modelos Dentários , Dente Molar/patologia , Osteotomia de Le Fort/métodos , Osteotomia Sagital do Ramo Mandibular/métodos , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: The aim of this in vitro study was to analyze color stability of monocrystalline and polycrystalline ceramic brackets after immersion in dye solutions. METHODS: Seven ceramic brackets of four commercial brands were tested: Two monocrystalline and two polycrystalline. The brackets were immersed in four dye solutions (coffee, red wine, Coke and black tea) and in artificial saliva for the following times: 24 hours, 7, 14 and 21 days, respectively. Color changes were measured by a spectrophotometer. Data were assessed by Multivariate Profile Analysis, Analysis of Variance (ANOVA) and Multiple Comparison Tests of means. RESULTS: There was a perceptible change of color in all ceramic brackets immersed in coffee (ΔE* Allure = 7.61, Inspire Ice = 6.09, Radiance = 6.69, Transcend = 7.44), black tea (ΔE* Allure = 6.24, Inspire Ice = 5.21, Radiance = 6.51, Transcend = 6.14) and red wine (ΔE* Allure = 6.49, Inspire Ice = 4.76, Radiance = 5.19, Transcend = 5.64), but no change was noticed in Coke and artificial saliva (ΔE < 3.7). CONCLUSION: Ceramic brackets undergo color change when exposed to solutions of coffee, black tea and red wine. However, the same crystalline structure, either monocrystalline or polycrystalline, do not follow the same or a similar pattern in color change, varying according to the bracket fabrication, which shows a lack of standardization in the manufacturing process. Coffee dye produced the most marked color changes after 21 days of immersion for most ceramic brackets evaluated.