Facial and dental parameters of reference used to indicate orthodonticsurgical treatment to patients with Class II dentofacial deformities

O objetivo do presente estudo foi determinar os parâmetros morfológicos, faciais e dentários, que devem ser utilizados como referência pelo profissional, ortodontista e cirurgião, para indicação do tratamento ortodôntico-cirúrgico em pacientes com deformidades dentofaciais do Padrão II. Foram selecionados 40 pacientes brasileiros, com crescimento finalizado, 26 do gênero feminino e 14 do masculino, com ângulo de convexidade facial maior que 12º e exposição gengival no sorriso igual ou menor a 3 mm. Foram excluídos os indivíduos xantodermas e melanodermas ou aqueles que já se submeteram a qualquer cirurgia facial. Foram obtidas fotografias extrabucais de frente, de perfil e do sorriso, fotografias intrabucais frontal e laterais direita e esquerda, modelos de gesso e telerradiografias do perfil facial de todos os pacientes. Toda essa documentação foi digitalizada e os arquivos enviados para 30 professores de cursos de Pós-graduação em Ortodontia. Os avaliadores foram solicitados a determinar, em uma lista de fatores relacionados ao diagnóstico ortodôntico, os que eles consideravam de extrema, moderada ou pequena/nenhuma importância na indicação da cirurgia ortognática. Posteriormente, deveriam avaliar os arquivos com as documentações ortodônticas para classificar a estética facial (agradável; aceitável; desagradável) e a melhor opção de tratamento (tratamento ortodôntico compensatório; tratamento ortodôntico-cirúrgico; nenhum tratamento) para cada paciente da amostra. Foram obtidas as medidas das variáveis da análise facial numérica do perfil nas fotografias do perfil facial, da sobressaliência e da sobremordida nos modelos de gesso, das inclinações dos incisivos superiores e inferiores, além do tipo facial, nas telerradiografias do perfil. Testou-se, então, a associação entre cada uma das variáveis acima, além da idade e do gênero, e a indicação do tratamento ortodôntico-cirúrgico e, a partir das variáveis que apresentaram associação, estabeleceu-se uma equação matemática que permite prever a probabilidade de indicação da cirurgia para pacientes Padrão II. Os fatores considerados de extrema importância na indicação da cirurgia ortognática, por pelo menos 50% dos avaliadores, em ordem decrescente de importância, foram os seguintes: estética facial, assimetria facial, convexidade do perfil facial, proporção entre os terços faciais médio e inferior, comprimento da linha queixo-pescoço, idade, exposição gengival no sorriso, projeção anterior do mento, exposição dos incisivos em repouso e sobressaliência. As variáveis que apresentaram associação com a indicação do tratamento ortodôntico-cirúrgico foram a estética facial, o ângulo de convexidade facial total, a sobressaliência e a inclinação do incisivo superior (1.PP). O modelo matemático proposto para prever a porcentagem de indicação de cirurgia ortognática em pacientes com deformidades dentofaciais do Padrão II inclui a estética facial, a sobressaliência e o ângulo de convexidade facial total. A equação visa prover o clínico de uma ferramenta auxiliar na decisão do tratamento dos pacientes Padrão II, principalmente nos casos limítrofes.The aim of the present study was to determine the morphological parameters, facial and dental, that may be used as references by the professional, either orthodontist or surgeon, to indicate compensatory orthodontic treatment or orthodontic-surgical treatment to patients with Class II dentofacial deformities. Forty brazilian leucoderma patients have been selected, 26 female and 14 male, all of them with growth finished, convexity facial angle higher than 12° and gingival exposure at smile equal or less than 3mm. It has been excluded the ones who have gone through facial surgery. Extrabucal photographs at the frontal, profile and smile views and intrabucal at the frontal, right lateral and left lateral views, plaster casts and lateral cephalometric radiograph have been taken of all patients. This documentation was digitalized and the archives sent to 30 post-graduation course orthodontic teachers of different parts of the country. The appraisers were asked to determine, in a list of factors related to orthodontic diagnosis, the ones they considered of extreme, moderate, little or no importance at the indication of orthognathic surgery. Subsequently, they evaluated the archives with the orthodontic documentation to classify the facial esthetic (pleasant, acceptable, and unpleasant) and the best treatment option (orthodontic compensatory treatment; orthodontic-surgical treatment; no treatment) to each patient of the sample. The measurements of the variables of the numerical facial analysis of the profile have been obtained at the photographs of the facial profile, the overjet and overbite at the plaster casts, and the inclination of the upper and lower incisors and the facial type at the lateral cephalometric radiograph. Then, the association between each of the variables mentioned above, age and gender, and the indication of the orthodontic-surgical treatment were tested. From the variables that showed association, a mathematic equation that allowed to foresee the indication of surgery to patients with Class II dentofacial deformities was established. The factors considered of extreme importance to indicate orthognathic surgery for at least fifty percent of the appraisers, in decreasing order of importance were: facial esthetics, facial assimetry, convexity of the facial profile, proportion between medium and lower facial thirds, length of the chin-neck line, age, gingival exposure at smile, chin anterior projection, incisor exposure at rest and overjet. The variables that showed association with the indication of orthodontic-surgical treatment were: facial esthetics, total facial convexity angle, overjet and upper incisor inclination (1.PP). The mathematic model proposed to foresee the percentage of indication of orthognathic surgery to patients with Class II dentofacial deformities includes facial esthetics, total facial convexity angle and overjet. The equation aims to provide the clinicians with an auxiliary tool at the treatment decision of the patients with Class II dentofacial deformities, especially at borderline cases

Características clínicas e cefalométricas associadas ao tratamento de paciente com mordida aberta

As principais características clínicas e cefalométricas referentes à mordida aberta anterior e posterior foram observadas pelos autores através de uma extensa revisão da literatura nacional e internacional. Foram revistas as características, tipos, etiologia, tratamento e estabilidade ao longo do tempo, onde se pode observar que a má oclusão de mordida aberta é um desafio comum à clínica odontológica. Em conclusão observou-se que o tratamento das MAs pode ser realizado em diferentes estágios da dentição através de recursos ortopédicos, ortodônticos e/ou cirúrgicos. Contudo, a realização do tratamento nos estágios de dentição decídua ou dentição mista permitirão resultados mais eficientes e estáveis ao longo do tempo.

Forces in stainless steel, TiMolium® and TMA® intrusion arches, with different bending magnitudes Forças em arcos de intrusão, em aço inoxidável, TiMolium® e TMA®, com diferentes magnitudes de deflexão

The present study compared forces in stainless steel, TiMolium® and TMA®, V-bend intrusion arches with different magnitudes of flexion. The sample consisted of rectangular-section wires, caliber .017" x .025", with ten arches of each alloy. All V-bends were made 48 mm from the midline, using the same phantom upper jaw, maintaining the same distance between the tubes fixed to the molars and the midline. Loads necessary to deflect the arches by 5, 10, 15 and 20 mm were measured by means of an Instron dynamometer with a 1 kgf load cell. Calculations for sample size confirmed the suitability of using 10 arches of each alloy. Variance tests (ANOVA) of one factor and three levels, complemented by the Tukey test for multiple comparisons, identified that TMA® intrusion arches required a smaller quantity of load in relation to conventional steel and TiMolium® at all levels of flexion. Furthermore, TiMolium® presented intermediary characteristics between steel and TMA®, and in all alloys increase in distance entailed a significant increase in force between all registered values, and that the increase in load necessary to deflect the arches at the intervals tended to decrease from first to last interval, these differences being more significant in steel, less in TiMolium® and practically non-existent in TMA®.O presente estudo comparou as forças em arcos de intrusão com dobra V confeccionados em aço inoxidável, TiMolium® e TMA®, com diferentes magnitudes de deflexão. A amostra constou de fios de secção retangular e calibre 0,017" x 0,025", com dez arcos de cada liga. Todas as dobras em V foram confeccionadas a 48 mm distantes da linha média, e foi utilizado o mesmo manequim de maxila para manter a mesma distância entre os tubos fixados nos molares e a linha média. As cargas necessárias para defletir os arcos em 5, 10, 15 e 20 mm foram mensuradas por meio de dinamômetro com célula de carga de 1 kgf, da marca Instron. O cálculo para o tamanho de amostra confirmou a possibilidade de se utilizar dez arcos de cada liga. Os testes de variância (ANOVA) de um fator e três níveis, complementados com os testes de Tukey para comparações múltiplas, identificaram que os arcos de intrusão de TMA® requereram menor quantidade de carga em relação ao aço convencional e ao TiMolium® em todos os níveis de deflexão; que o TiMolium® apresentou características intermediárias entre o aço e o TMA®; que em todas as ligas o aumento das distâncias implicou em aumento significativo da força entre todos os valores registrados; e que os incrementos de carga necessários para defletir os arcos nos intervalos tenderam a decrescer do primeiro ao último intervalo, sendo essas diferenças mais significantes no aço, menores no TiMolium® e praticamente inexistentes no TMA®

Correlation between transverse expansion and increase in the upper arch perimeter after rapid maxillary expansion

The purpose of the present study was to assess the correlation between transverse expansion and the increase in upper arch perimeter, after maxillary expansion. Dental casts of eighteen patients were obtained before treatment and again five months after maxillary expansion. Measurements of intermolar width, intercanine width, arch length and arch perimeter were made with a digital caliper on photocopies taken from the dental casts. After assessment of the method error, a multiple regression model was developed following the identification of the best subset of variables. The resulting equation led to the conclusion that the increase in arch perimeter is approximately given by the addition of 0.54 times the intercanine expansion, and 0.87 times the arch length alteration

Age-related changes in the Brazilian woman’s smile

Abstract The aim of this research was to evaluate age-related changes in the smile of Brazilian women. The sample consisted of 249 Brazilian women who had not undergone previous orthodontic treatment or facial surgery. They were divided into four groups, according to age: G1 (20-29), G2 (30-39), G3 (40-49) and G4 (50 or older). Standardized front view photographs were taken while smiling and at rest. Measurements were evaluated by ANOVA and post-hoc Tukey. The Chi-square test was applied for qualitative variables. Upper lip thickness at rest and exposure of upper incisors on smiling decreased with age. Most individuals (60.9%) exhibited a medium smile. High smiles were more often seen in G1 (45%) and less frequently in G4 (18.8%), whereas the opposite occurred with the low smile, i.e., G4 (21.9%) and G1 (6.7%). Variations among the groups were observed in the transverse exposure of the teeth on smiling. In G1 and G3, there was a balance between tooth exposures, so that the teeth were exposed as far as the premolars and/or molars. Most of the women (56.3%) in G2 exposed their teeth as far as the first molars on smiling, whereas most of those (40.6%) in G4 exposed their teeth only as far as the first premolars on smiling. As age increased, there was decreased exposure of the upper incisors, decreased upper lip thickness and lower exposure of teeth vertically and transversely

Association between overbite and craniofacial growth pattern

The purpose of the present study was to assess the association between overbite and craniofacial growth pattern. The sample comprised eighty-six cephalograms obtained during the orthodontic pretreatment phase and analyzed using the Radiocef program to identify the craniofacial landmarks and perform orthodontic measurements. The variables utilized were overbite, the Jarabak percentage and the Vert index, as well as classifications resulting from the interpretation of these measurements. In all the statistical tests, a significance level of 5% was considered. Measurement reliability was checked by calculating method error. Weighted Kappa analysis showed that agreement between the facial types defined by the Vert index and the direction of growth trend established by the Jarabak percentage was not satisfactory. Owing to this lack of equivalency, a potential association between overbite and craniofacial growth pattern was evaluated using the chi-square test, considering the two methods separately. No relationship of dependence between overbite and craniofacial growth pattern was revealed by the results obtained. Therefore, it can be concluded that the classification of facial growth pattern will not be the same when considering the Jarabak and the Ricketts anayses, and that increased overbite cannot be associated with a braquifacial growth pattern, nor can openbite be associated with a dolichofacial growth pattern