Caracterização cefalométrica dento-esquelética e das vias aéreas superiores em indivíduos com mordida aberta

Introdução: A mordida aberta (MA) apresenta-se como uma má oclusão definida pela ausência de trespasse vertical com diversas características morfológicas que influenciam o diagnóstico e dificultam o tratamento. Objetivos: avaliação cefalométrica das vias aéreas superiores em indivíduos com MA anterior e de outros parâmetros dento-esqueléticos. Materiais e métodos: estudo epidemiológico transversal descritivo e observacional, no qual foram avaliados 31 indivíduos com MA (grupo de amostra) com idades compreendidas entre os 15 e os 46 anos e de raça caucasiana. Resultados: no grupo de controlo analisado 67,74% apresenta um biótipo dolicofacial. As características que se apresentaram significativamente diminuídas na avaliação do grupo com MA são o eixo facial (p-value=0.001), ângulo do plano palatino (p-value=0.000), ODI (p-value=0.000), espaço nasofaríngeo (p-value=0.000), AFP/AFA (p-value=0.003), profundidade facial (p-value=0.047 em homens e p-value=0.012 em mulheres), sobremordida vertical (p-value=0.000), extrusão do incisivo inferior (p-value=0.000) e ângulo interincisal (p-value=0.000). Características como a altura facial inferior (p-value=0.000), protrusão do incisivo inferior (p-value=0.000), protrusão do incisivo superior (p-value=0.000), inclinação do incisivo inferior (p-value=0.000), distância do plano mandibular ao osso hioide (p-value=0.019), distância da epiglote ao palato mole (p-value=0.003) e distância dentoalveolar do primeiro molar superior ao plano palatino (p-value=0.022) encontram-se significativamente aumentadas. Conclusões: Uma das características cefalométricas mais preponderantes em indivíduos com MA é o biótipo dolicofacial (associado a um eixo facial e profundidade facial diminuídos, e altura facial inferior aumentada). O ODI, ângulo do plano palatino e ângulo interincisivo apresentam-se diminuídos. Verifica-se um aumento dentoalveolar a nível do primeiro molar e diferença mais pronunciada entre alturas faciais nos indivíduos com MA. Observa-se uma diminuição a nível do espaço nasofaríngeo. Apresenta-se também no incisivo inferior uma menor extrusão e uma inclinação aumentada. Tanto o incisivo superior como o inferior apresentam uma protrusão aumentada.Introduction: The open bite (OB) is a malocclusion defined by the absence of overbite with various morphologic characteristics that influence the diagnosis and hamper the treatment. Objectives: cephalometric evaluation of the upper airways in individuals with anterior OB and other dento-skeletal parameters. Materials and methods: descriptive and observational cross-sectional epidemiological study, where 31 individuals of Caucasian race with OB were evaluated (sample group) ranging from 15 to 46 years of age. Results: In the sample group 67,74% presented a dolicofacial biotype. The following characteristics were found to be significantly lower in the OB group: facial axis (p-value=0.001), palatine plane angle (p-value=0.000), ODI (p-value=0.000), nasopharyngeal space (p-value=0.000), AFP/AFA (p-value=0.003), facial depth (p-value=0.047 in men and p-value=0.012 in women), overbite (p-value=0.000), lower incisor extrusion (p-value=0.000) and interincisal angle (p-value=0.000). Characteristics such as lower facial height (p-value=0.000), lower incisor protrusion (p-value=0.000), upper incisor protrusion (p-value=0.000), lower incisor inclination (p-value=0.000), distance from the mandibular plane to hyoid bone (p-value=0.019), distance from epiglottis to soft palate (p-value=0.003) and dentoalveolar distance from first upper molar to palatine plane (p-value=0.022) were found to be significantly increased. Conclusions: The dolicofacial biotype (associated with and increased lower facial height and decreased facial axis and facial depth) shown to be preponderant in OB individuals. The ODI, palatal plane angle and interincisal angle are diminished, and there is an increased dentoalveolar distance at the first molar level, and a more pronounced difference between facial heights in OB individuals. There is an increase in the vertical dimension of the upper airways and a decrease in terms of the nasopharyngeal space. The lower incisor showed a decreased extrusion and augmented inclination. Both the lower and upper incisors show a significantly increased protrusion in the sample group

Application of Three-Dimensional Digital Technology in Orthodontics: The State of the Art

Three-dimensional technologies are one of the most recent and relevant advancements in the field of Dentistry. These systems, including intraoral scans, 3D imaging exams (CAT scan, CBCT and MRI), CAD/CAM 3D printing devices and 3D computer software, have enabled clinicians to greatly improve patient care along with reducing treatment planning time. The present descriptive study aims to explore possible applications of 3D technologies during the diagnosis, treatment plan, case monitoring and result assessment in orthodontics. The overall upgrade provided by these technologies can improve the clinicians' workflow and effectiveness by simplifying conventional techniques considered to be especially arduous

#071 Recobrimento de recessão: técnica VISTA e enxerto de tecido conjuntivo subepitelial

Introdução: A manifestação clínica da recessão gengival é o deslocamento apical dos tecidos gengivais, tendo como referência a linha amelocementária (LAC), com consequente exposição da superfície radicular ao meio oral. A técnica VISTA utilizando um enxerto de tecido conjuntivo subepitelial tem sido descrita, ao longo da última década, como um procedimento de cirurgia plástica periodontal eficaz tanto no recobrimento de recessões gengivais unitárias, como em recessões gengivais múltiplas adjacentes, classes I e II de Miller. Descrição do caso clínico: Paciente do sexo masculino, 21 anos, ASA I e não fumador. O motivo da consulta deveu? se a um defeito estético, no dente 4.1. Foi diagnosticada como gengivite leve ou inicial induzida por placa (PI=12,3% e BOP=3,5%). Apresentava uma recessão classe III de Miller de 4 mm, em vestibular, no dente 4.1. O plano de tratamento passou pela realização de fase higiénica, condicionamento radicular com tetraciclinas e cirurgia periodontal plástica – técnica VISTA e Enxerto de Tecido Conjuntivo Subepitelial. A técnica VISTA começa com uma incisão de acesso mesial à recessão a ser tratada. Através da incisão é criado um túnel subperiósteo, expondo a tábua óssea vestibular e a deiscência radicular com um elevador periosteal microcirúrgico. O túnel é estendido um a dois dentes, no mínimo, para além do dente que requer recobrimento radicular, para mobilizar as margens gengivais e facilitar o seu reposicionamento coronal. Segundo Zucchelli et al obteve? se um enxerto gengival livre do palato duro que foi posteriormente desepitelizado. Por fim, o retalho e o complexo mucogengival foram avançados coronalmente e estabilizados na sua nova posição com uma técnica de sutura ancorada nas coroas dentárias. O complexo mucogengival é avançado e é estabilizado com uma técnica de sutura ancorada coronalmente. Foi prescrito um analgésico ao paciente e o mesmo foi aconselhado a fazer bochechos diários com clorhexidina, durante três semanas. O paciente foi submetido a um controlo periodontal regular, por 6 meses. Discussão e conclusões: Pensa?se que o uso de aparelho ortodôntico (fixo), associado a um biótipo gengival fino, poderá ter sido o fator etiológico da recessão. A técnica VISTA parece melhorar o biótipo gengival, tratar com sucesso as recessões gengivais (neste caso unitária – recobrimento radicular total no dente 4.1), sem formação de cicatriz, evitando? se algumas das possíveis complicações das técnicas de tunelização intrasulcular.info:eu-repo/semantics/publishedVersio

Reconstruction of Oronasal Fistula with Tongue Flap: A Cleft Palate Report

Oronasal fistula can persist after conventional secondary alveolar bone graft surgery, which may lead to functional issues, such as regurgitation of fluids from the oral to the nasal cavity. This manuscript describes a clinical case of a patient with a bilateral cleft lip and palate that underwent tongue graft surgery for closure of an oronasal fistula after three failed local mucosa flap surgeries. The multidisciplinary treatment was comprised of orthodontic treatment, mucosa and alveolar grafts for palate closure and aesthetic rehabilitation of the anterior maxillary teeth. Smile aesthetics were noticeably improved, enhancing the patient’s self-perception and confidence

Relapse after Orthodontic-Surgical Treatment: A Retrospective Longitudinal Study

Long-term stability is a crucial point in order to keep the patient’s aesthetic and functional balance. The aim of this study was to evaluate dental and skeletal relapse in patients who underwent orthodontic-surgical treatment. This retrospective study included 25 patients who corrected their dentofacial deformity through orthodontics and orthognathic surgery. The dental casts and lateral cephalograms were evaluated prior to orthodontic treatment (T0), final of orthodontic-surgical treatment (T1) and long-term retention phase (T2). The Wilcoxon test with p-value corrected by the Benjamini–Hochberg method was used to assess differences between the groups. The influence of retention duration was assessed using the Kruskal–Wallis method. The association of nominal variables and differences between quantitative variables were assessed using the Fisher and Mann– Whitney tests, respectively. No dental or skeletal variable presented statistically significant differences between the final orthodontic-surgical treatment and the long-term retention phase. Eight patients presented dental relapse (32–95% CI [12.4%; 51.7%]), but no skeletal relapse was observed in any of the 25 individuals. The type of malocclusion did not influence the relapse rate of orthodontic-surgical treatment (Fisher, p = 0.202). No differences were found between the different retention times, sex and age at the end of treatment. Orthodontic-surgical treatment showed long-term stability in the present study group

Velopharyngeal Insufficiency Treatment in Cleft Palate Patients: Umbrella Review

Velopharyngeal insufficiency may occur as a result of an anatomical or structural defect and may be present in patients with cleft lip and palate. The treatment options presented in the literature are varied, covering invasive and non-invasive methods. However, although these approaches have been employed and their outcomes reviewed, no conclusions have been made about which approach is the gold-standard. This umbrella review aimed to synthesize the current literature regarding velopharyngeal insufficiency treatments in cleft lip and palate patients, evaluating their effectiveness based on systematic reviews. A standardized search was carried out in several electronic databases, namely PubMed via Medline, Web of Science, Cochrane Library, and Embase. The quality of the included studies was evaluated using AMSTAR2 and degree of overlap was analyzed using Corrected Covered Area. Thirteen articles were included in the qualitative review, with only 1 in the non-invasive method category, and 12 in the invasive method category. All reviewed articles were judged to be of low quality. In symptomatic patients, treatment did not solely comprise speech therapy, as surgical intervention was often necessary. Although there was no surgical technique considered to be the gold standard for the correction of velopharyngeal insufficiency, the Furlow Z-plasty technique and minimal incision palatopharyngoplasty were the best among reported techniques

Three-Dimensional Pulp Volume Analysis in Lip and Palate Cleft Population

Aim: Cleft lip and palate (CLP) patients have a greater predisposition to tooth malformation, which could affect pulp volume. The aim of this study is to evaluate the dental pulp volume of central incisors in 3D images between individuals with and without CLP. Materials and Methods: This retrospective case-control study is single-centered and was recruited between January 2016 and October 2022. Ninety-four patients who were followed in the Institute of Orthodontics were evaluated and divided into two groups: a control group of patients without CLP and a test group of patients with CLP. The 3D data were imported by 3D image semi-automatic segmenting software named ITK-SNAP to calculate tooth pulp volume. Results: The dental pulp volume for both groups, control and CLP, did not show statistically significant differences. In the cleft group, when comparing the pulp volume between the cleft side and the non-cleft side, the cleft side showed a smaller volume. Regarding age and sex, no statistically significant differences were observed. Conclusions: Although there are no differences in mean pulp volume between patients with and without CLP, there is a pulp volume reduction in the teeth on the cleft side when compared to the unaffected contralateral side

Three-Dimensional Impression of Biomaterials for Alveolar Graft: Scoping Review

Craniofacial bone defects are one of the biggest clinical challenges in regenerative medicine, with secondary autologous bone grafting being the gold-standard technique. The development of new three-dimensional matrices intends to overcome the disadvantages of the gold-standard method. The aim of this paper is to put forth an in-depth review regarding the clinical efficiency of available 3D printed biomaterials for the correction of alveolar bone defects. A survey was carried out using the following databases: PubMed via Medline, Cochrane Library, Scopus, Web of Science, EMBASE, and gray literature. The inclusion criteria applied were the following: in vitro, in vivo, ex vivo, and clinical studies; and studies that assessed bone regeneration resorting to 3D printed biomaterials. The risk of bias of the in vitro and in vivo studies was performed using the guidelines for the reporting of pre-clinical studies on dental materials by Faggion Jr and the SYRCLE risk of bias tool, respectively. In total, 92 publications were included in the final sample. The most reported three-dimensional biomaterials were the PCL matrix, β-TCP matrix, and hydroxyapatite matrix. These biomaterials can be combined with different polymers and bioactive molecules such as rBMP-2. Most of the included studies had a high risk of bias. Despite the advances in the research on new three-dimensionally printed biomaterials in bone regeneration, the existing results are not sufficient to justify the application of these biomaterials in routine clinical practice

Three-Dimensional Impression of Biomaterials for Alveolar Graft: Scoping Review

Craniofacial bone defects are one of the biggest clinical challenges in regenerative medicine, with secondary autologous bone grafting being the gold-standard technique. The development of new three-dimensional matrices intends to overcome the disadvantages of the gold-standard method. The aim of this paper is to put forth an in-depth review regarding the clinical efficiency of available 3D printed biomaterials for the correction of alveolar bone defects. A survey was carried out using the following databases: PubMed via Medline, Cochrane Library, Scopus, Web of Science, EMBASE, and gray literature. The inclusion criteria applied were the following: in vitro, in vivo, ex vivo, and clinical studies; and studies that assessed bone regeneration resorting to 3D printed biomaterials. The risk of bias of the in vitro and in vivo studies was performed using the guidelines for the reporting of pre-clinical studies on dental materials by Faggion Jr and the SYRCLE risk of bias tool, respectively. In total, 92 publications were included in the final sample. The most reported three-dimensional biomaterials were the PCL matrix, β-TCP matrix, and hydroxyapatite matrix. These biomaterials can be combined with different polymers and bioactive molecules such as rBMP-2. Most of the included studies had a high risk of bias. Despite the advances in the research on new three-dimensionally printed biomaterials in bone regeneration, the existing results are not sufficient to justify the application of these biomaterials in routine clinical practice

Realistic Facial Three-Dimensional Reconstruction from CT Images and 2D Photographic Images for Surgical-Orthognathic Planning

Orthognathic surgery is a procedure used to correct intermaxillary discrepancies, thus promoting significant improvements in chewing and breathing. During the surgical planning stage, orthodontists often use two-dimensional imaging techniques. The assessment is based on CBCT images and dental cast models to overcome these limitations; however, the evaluation of soft tissues remains complex. The aim of the present study was to develop a co-registration method of CBCT and photo images that would result in realistic facial image reconstruction. CBCT images were three-dimensionally rendered, and the soft tissues were subsequently segmented resulting in the cranial external surface. A co-registration between the obtained surface and a frontal photo of the subject was then carried out. From this mapping, a photorealistic model capable of replicating the features of the face was generated. To assess the quality of this procedure, seven orthodontists were asked to fill in a survey on the models obtained. The survey results showed that orthodontists consider the three-dimensional model obtained to be realistic and of high quality. This process can automatically obtain a three-dimensional model from CBCT images, which in turn may enhance the predictability of surgical-orthognathic planning