A relação maxilo-mandibular e apófise odontóido, qual a relação? O estudo cefalométrico

Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas MonizObjetivos: Avaliar a relação entre a postura crânio-cervical e a mudança maxilo-mandibular. Realizado com base em medições angulares de telerradiografias de perfil de 90 pacientes classificadas de acordo com os seus deslocamentos esqueléticos em três grupos I, II e III. Estas medições referiam-se principalmente ao processo odontoide, à maxila e à mandíbula. Materiais e Métodos: Neste estudo, as radiografias de perfil utilizados são seleccionados de acordo com a idade do paciente: foram tomados pacientes com mais de 13 anos. As medições são feitas à mão pela mesma pessoa em radiografias de perfil de 90 pacientes com oclusão classificados em 3 grupos de acordo com as suas classes esqueléticas. Esta classificação é feita de acordo com o ângulo ANB. As medidas angulares são definidas a partir de quatro planos; plano Mac Gregor (MGP), plano Odontoide (OP), plano Palatino (PP) e plano Mandibular (Pmd). A partir destes planos, foram feitas as seguintes medições angulares: Ângulo Cranio-cervical (OP/MGP), ângulo Cervico-maxilar(OP/PP) e ângulo Cervico-mandibular (OP/PMD). Foram realizadas análises estatísticas de correlações utilizando o software "IBM SPSS Statistics 26.0". Com este modelo estatístico, uma correlação é significativa se o coeficiente de pearsan (p) é inferior ou igual a 0,05. Resultados: Este estudo mostrou que 48% dos pacientes que consultaram por má oclusão ortodôntica tinham um ângulo craniocervical patológico (OP/MGP). Uma intercorrelação é identificada entre o mudança esquelético e o posicionamento do processo odontoide relacionado principalmente com a mandíbula e a maxila para a classe esquelética III e apenas com a maxila para a classe esquelética II. Conclusão: Não existe uma relação significativa entre a postura cervical e o tipo de classe esquelética e entre a divergência vertical e o tipo esquelético. Contudo, existe uma correlação significativa entre a posição do processo odontoide e a relação maxilo-mandibular nas classes esqueléticas II e III.Objectives: Evaluate the relationship between cranio-cervical posture and maxillomandibular shift. This study was based on angular measurements of profile teleradiographs of 90 patients classified according to their skeletal shifts into three groups I, II and III. These measurements referred mainly to the odontoid process, the maxillary and the mandibular. Materials and Methods: In this study, the profile teleradiographs were selected according to the age of the patient: patients older than 13 years were taken. Measurements are done by hand by the same person on profile teleradiographs of 90 patients with occlusion classified into 3 groups according to their skeletal classes. This classification is done according to the ANB angle. Angular measurements are defined from four planes; Mac Gregor plane (MGP), Odontoid plane (OP), Palatal plane (PP) and Mandibular plane (Pmd). From these planes, the following angular measurements were made: Cranio-cervical angle (OP/MGP), Cervico-maxillary angle (OP/PP) and Cervico-mandibular angle (OP/PMD). Statistical analyses of correlations were performed using the software "IBM SPSS Statistics 26.0". With this statistical model, a correlation is significant if the pearsan coefficient (p) is less than or equal to 0.05. Results: This study showed that 48% of patients consulting for orthodontic malocclusion had a pathological craniocervical angle (OP/MGP). An intercorrelation is identified between the skeletal shift and the positioning of the odontoid process related mainly to the mandible and maxilla for skeletal class III and only to the maxilla for skeletal class II. Conclusion : There is no significant relationship between cervical posture and skeletal class type and between vertical divergence and skeletal class type. However, there is a significant correlation between the position of the odontoid process and the maxillomandibular relationship in skeletal classes II and III.Objectives : Etudier la corrélation entre la posture cervicale et le décalage crânio-facial. Cette étude est menée par des mesures angulaires à partir des téléradiographies de profil de 90 patients classés selon leurs décalages squelettiques en trois groupes I, II et III. Ces mesures ont concerné principalement le processus odontoïde, le maxillaire et la mandibule. Matériels et Méthodes : Les téléradiographies de profil utilisées dans cette étude sont sélectionnées en fonction de l’âge de patient : pour faciliter le tracé de plan odontoïde, on a pris que les patients ayant plus de 13 ans. Les mesures sont faites à la main par la même personne sur des radios de profil de 90 patients présentant des malocclusions classées sur 3 groupes selon leurs classes squelettiques. Cette classification est faite selon l’angle ANB. Les mesures angulaires sont définies à partir de quatre plans ; Plan de Mac Gregor (MGP), Plan Odontoïde (OP), Plan palatin (PP) et Plan mandibulaire (Pmd). A partir de ses plans, on a fait les mesures angulaires suivants : Angle crânio-cervical (OP/MGP), Angle cervico-maxillaire (OP/PP) et Angle cervico-mandibulaire (OP/PMD). Les analyses statistiques de corrélation sont faites à l’aide de logiciel « IBM SPSS Statistics 26.0 ». Avec ce modèle statistique, une corrélation est significative si le coefficient de pearson (p) est inférieur ou égale à 0,05. Résultats : Cette étude a montré que 48 % de patients qui ont consulté pour malocclusion en orthodontie présentaient un angle crânio-cervical (OP/MGP) pathologique. Une intercorrélation est identifiée entre le décalage squelettique et le positionnement de processus odontoïde liée principalement à la mandibule et au maxillaire pour la classe squelettique III et seulement au maxillaire pour la classe squelettique II. Conclusion : Il n’existe pas de relation significative entre la posture cervicale et le type de décalage squelettique et entre la divergence cervicale et le type de décalage squelettique. Cependant, il existe une corrélation significative entre la position de processus odontoïde et le décalage squelettique de type II et III

The measurement of craniofacial morphology head posture and nasal airflow in patients with congenital clefts of the lip and palate

The present study was both methodological and investigative in nature. This included the development of computerised rhinomanometry and establishment of cephalometric measurement apparatus together with a standardised lateral cephalometric radiography technique to record natural head posture.The method errors of both the measurement systems and the operator were tested by duplicate determinations and subsequent statistical analysis. Recordings for all the variables in the study were reproducible without systematic error and with a very small method error.Apparatus was used to record nasal respiratory resistance (NRR), craniofacial form and head posture in a control group for comparison with subjects with cleft lip (CL), cleft palate (CP), and unilateral cleft lip and palate (UCLP).The results of the rhinomanometric recording indicated that the bilateral nasal resistance did not differ significantly between the cleft samples and the controls. Unilateral measurements of nasal resistance showed higher values for the cleft side than for the non-cleft side, both in cleft lip (CL) and the unilateral cleft lip and palate (UCLP) samples. In the cleft palate (CP) sample as well as in the controls, unilateral nasal resistance did not differ between the two sides.Comparisons were made between cephalometric measurements for craniofacial form and head posture for each category of the clefting deformity and the controls and the statistically significant differences tabulated.Previous studies have demonstrated associations between cranio-cervical angulation and craniofacial morphology, and between airway adequacy and cranio-cervical angulation.In the present study, differences and correlations were calculated between face height, head posture and airway resistance which were in agreement with the predicted pattern of associations between cranio-cervical angulation and craniofacial morphology (face height) and between airway adequacy and cranio-cervical angulation

Da disfunção respiratória na estruturação craniofacial

Dissertação de Doutoramento em Medicina Dentária, área de especialização em Odontopediatria e Ortodontia, apresentada à Faculdade de Medicina Dentária da Universidade do Port

Procena obrasca rasta i odnosa cervikalnih i kraniofacijalnih struktura

Ontogenesis represents unique qualitative and quantitative change of an organism, and it is process of somatic, functional and reproductive development of each individual from the time of fertilization to the organism’s mature form. Growth refers to a positive change in size of body over a period of time as a result of cellular proliferation and extracellular matrix secretion. Change of analyzed growth parameters over a period of time represents the characteristic growth pattern. The exact assessment of physical development of organs of human body and growth pattern of each individual is important for determination of extreme values under their standard norms or their deviation, and for diagnostic and therapeutically purposes. Changes in craniofacial system from birth to maturity are very characteristic. A lot of previous studies had shown the existence of correlation between growth and development of craniofacial and cervical structures. It has been shown that posture of cervical vertebra is influenced by several factors including: ethnicity, sex, age, constitution of the body, craniofacial morphology and orthodontic therapy. Based on previous research in our population there are no available data of growth and development parameters of craniofacial and cervical system, especially related to different age, sex and skeletal classes of patients. Additionally, influence of craniofacial parameters on growth and development of component of cervical system has not been thoroughly investigated. AIMS. This study aimed to determine the standard norms of parameters of craniofacial and cervical system in patients of our population with different age, sex and skeletal classes. The additional aims were to determine the correlation between craniofacial and cervical parameters and skeletal maturity of patients in our population based on morphological characteristics of cervical vertebra. MATERIAL AND METHODS. This retrospective study consisted of 540 patients of Clinic of orthodontics, School of dental medicine, University of Belgrade, both sex, divided in 3 skeletal classes according to Angle classification and in 9 age groups: I – 7.00-8.06, II – 8.07-10.00, III – 10.01-11.06, IV – 11.07-13.00, V – 13.01-14.06, VI – 14.07-16.00, VII – 16.01-17.06, VIII – 17.07-19.00 and IX – older than 19 years...Ontogenetsko razviće obuhvata jedinstven niz kvalitativnih i kvantitativnih promena organizma, te predstavlja proces sveukupnog somatskog (anatomsko–morfološkog), funkci-onalnog i reproduktivnog formiranja svake individue od njenog začeća do pune polne zrelosti. Rast je porast mase i veličine organizma koji nastaje kao posledica povećanja broja ćelija proliferacijom, rastom ćelija i sekrecijom ekstracelularnog matriksa. Promena vrednosti analiziranih parametara rasta u odreĎenim vremenskim intervalima predstavlja karakterističan obrazac rasta. Tačna procena fiziološkog razvoja pojedinih organskih sistema i obrazac rasta svake individue vaţni su radi odreĎivanja ekstremnih vrednosti unutar fizioloških varijacija ili njihovog odstupanja, te postavljanja pravilne dijagnoze i sprovoĎenja adekvatne terapije. Promene u predelu kraniofacijalnog sistema od roĎenja do odraslog doba su izrazite i veoma upadljive. Mnogobrojna istraţivanja su pokazala da postoji povezanost izmeĎu rasta i razvoja kraniofacijalnih i cervikalnih struktura. Pokazano je da na poloţaj vratnog dela kičmenog stuba utiču mnogobrojni faktori poput: etničke pripadnosti, pola, uzrasta, konstitucije, kraniofacijalne morfologije, kao i ortodontska terapija. Sa aspekta procene obrasca rasta, u dosadašnjim istraţivanjima još uvek nisu analizirani parametri rasta i razvoja kranio-facijalnog i cervikalnog sistema u našoj populaciji u odnosu na različite uzraste i pol pa-cijenata, kao i različite skeletne klase. Dodatno, nedovoljno je ispitan uticaj kraniofacijalnih parametara na rast i razvoj komponenti cervikalnog segmenta kičmenog stuba. CILJ ISTRAŢIVANJA. Ovo istraţivanje je imalo za cilj da odredi vrednosti kranio-facijalnih parametara i parametara cervikalnog dela kičmenog stuba na ispitivanom uzorku pacijenata različite starosti, pola i skeletnih klasa. TakoĎe, cilj je bio i da se utvrdi postojanje meĎusobnog odnosa izmeĎu kraniofacijalnih i cervikalnih parametara u ispitivanoj populaciji pacijenata, kao i da se odredi skeletna zrelost pacijenata na osnovu morfoloških karakteristika cervikalnog dela kičmenog stuba. MATERIJAL I METOD. U retrospektivno istraţivanje uključeno je ukupno 540 pacijenata Klinike za ortopediju vilica Stomatološkog fakulteta Univerziteta u Beogradu, oba pola, podeljenih u tri skeletne klase, u skladu sa Angle-ovom klasifikacijom, i u devet starosnih grupa: I – 7.00-8.06, II – 8.07-10.00, III – 10.01-11.06, IV – 11.07-13.00, V – 13.01-14.06, 3 VI – 14.07-16.00, VII – 16.01-17.06, VIII – 17.07-19.00 i IX – stariji od 19 godina..

Assesment of growth pattern and relationship between cervical and craniofacial structures

Ontogenetsko razviće obuhvata jedinstven niz kvalitativnih i kvantitativnih promena organizma, te predstavlja proces sveukupnog somatskog (anatomsko–morfološkog), funkci-onalnog i reproduktivnog formiranja svake individue od njenog začeća do pune polne zrelosti. Rast je porast mase i veličine organizma koji nastaje kao posledica povećanja broja ćelija proliferacijom, rastom ćelija i sekrecijom ekstracelularnog matriksa. Promena vrednosti analiziranih parametara rasta u odreĎenim vremenskim intervalima predstavlja karakterističan obrazac rasta. Tačna procena fiziološkog razvoja pojedinih organskih sistema i obrazac rasta svake individue vaţni su radi odreĎivanja ekstremnih vrednosti unutar fizioloških varijacija ili njihovog odstupanja, te postavljanja pravilne dijagnoze i sprovoĎenja adekvatne terapije. Promene u predelu kraniofacijalnog sistema od roĎenja do odraslog doba su izrazite i veoma upadljive. Mnogobrojna istraţivanja su pokazala da postoji povezanost izmeĎu rasta i razvoja kraniofacijalnih i cervikalnih struktura. Pokazano je da na poloţaj vratnog dela kičmenog stuba utiču mnogobrojni faktori poput: etničke pripadnosti, pola, uzrasta, konstitucije, kraniofacijalne morfologije, kao i ortodontska terapija. Sa aspekta procene obrasca rasta, u dosadašnjim istraţivanjima još uvek nisu analizirani parametri rasta i razvoja kranio-facijalnog i cervikalnog sistema u našoj populaciji u odnosu na različite uzraste i pol pa-cijenata, kao i različite skeletne klase. Dodatno, nedovoljno je ispitan uticaj kraniofacijalnih parametara na rast i razvoj komponenti cervikalnog segmenta kičmenog stuba. CILJ ISTRAŢIVANJA. Ovo istraţivanje je imalo za cilj da odredi vrednosti kranio-facijalnih parametara i parametara cervikalnog dela kičmenog stuba na ispitivanom uzorku pacijenata različite starosti, pola i skeletnih klasa. TakoĎe, cilj je bio i da se utvrdi postojanje meĎusobnog odnosa izmeĎu kraniofacijalnih i cervikalnih parametara u ispitivanoj populaciji pacijenata, kao i da se odredi skeletna zrelost pacijenata na osnovu morfoloških karakteristika cervikalnog dela kičmenog stuba. MATERIJAL I METOD. U retrospektivno istraţivanje uključeno je ukupno 540 pacijenata Klinike za ortopediju vilica Stomatološkog fakulteta Univerziteta u Beogradu, oba pola, podeljenih u tri skeletne klase, u skladu sa Angle-ovom klasifikacijom, i u devet starosnih grupa: I – 7.00-8.06, II – 8.07-10.00, III – 10.01-11.06, IV – 11.07-13.00, V – 13.01-14.06, 3 VI – 14.07-16.00, VII – 16.01-17.06, VIII – 17.07-19.00 i IX – stariji od 19 godina...Ontogenesis represents unique qualitative and quantitative change of an organism, and it is process of somatic, functional and reproductive development of each individual from the time of fertilization to the organism’s mature form. Growth refers to a positive change in size of body over a period of time as a result of cellular proliferation and extracellular matrix secretion. Change of analyzed growth parameters over a period of time represents the characteristic growth pattern. The exact assessment of physical development of organs of human body and growth pattern of each individual is important for determination of extreme values under their standard norms or their deviation, and for diagnostic and therapeutically purposes. Changes in craniofacial system from birth to maturity are very characteristic. A lot of previous studies had shown the existence of correlation between growth and development of craniofacial and cervical structures. It has been shown that posture of cervical vertebra is influenced by several factors including: ethnicity, sex, age, constitution of the body, craniofacial morphology and orthodontic therapy. Based on previous research in our population there are no available data of growth and development parameters of craniofacial and cervical system, especially related to different age, sex and skeletal classes of patients. Additionally, influence of craniofacial parameters on growth and development of component of cervical system has not been thoroughly investigated. AIMS. This study aimed to determine the standard norms of parameters of craniofacial and cervical system in patients of our population with different age, sex and skeletal classes. The additional aims were to determine the correlation between craniofacial and cervical parameters and skeletal maturity of patients in our population based on morphological characteristics of cervical vertebra. MATERIAL AND METHODS. This retrospective study consisted of 540 patients of Clinic of orthodontics, School of dental medicine, University of Belgrade, both sex, divided in 3 skeletal classes according to Angle classification and in 9 age groups: I – 7.00-8.06, II – 8.07-10.00, III – 10.01-11.06, IV – 11.07-13.00, V – 13.01-14.06, VI – 14.07-16.00, VII – 16.01-17.06, VIII – 17.07-19.00 and IX – older than 19 years..

O efeito sobre as medidas cefalometricas devido à alteração da posição natural da cabeça (PNC) em telerradiografias tomadas em norma lateral

Orientador: Vânia Célia Vieira de SiqueiraDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Em 1884, os craniologistas adotaram o plano horizontal de Frankfurt, determinado pelos pontos Pório esquerdo, Pório direito e pelo ponto Infra-orbitário esquerdo, como sendo a referência que define a posição da cabeça enquanto paralela ao solo. Quando do surgimento da cefalometria, adotaram-se inúmeros pontos, linhas e planos de referência utilizados em craniometria, dentre os quais o plano horizontal de Frankfurt, porém somente com o desenvolvimento do cefalostato, em 1931, a validade do emprego dessas referências passou a ser questionada devido à dificuldade de localização dos pontos Pório e do Orbitário e à grande variabilidade interindividual de inclinação desse plano o que gera interpretações duvidosas nas análises cefalométricas nele baseadas. Dessa maneira a Posição Natural da Cabeça (PNC) associada a uma linha de referência extracraniana tornou-se objeto de interesse tanto para a antropologia quanto para a ortodontia por ser um posicionamento estável para as avaliações da estética facial, para o diagnóstico e para o estudo longitudinal do crescimento craniofacial. Este trabalho objetivou estudar as alterações das grandezas cefalométricas angulares e lineares mais comumente utilizadas em cefalometria, quando a posição natural da cabeça (PNC) é modificada durante a tomada da telerradiografia, sua influência no diagnóstico ortodôntico e a confiabilidade e reprodutibilidade da PNC em tomadas radiográficas sucessivas. Analisou-se 180 telerradiografias tomadas em norma lateral de 30 pacientes do sexo feminino com idade média de 21,3 anos obtidas em duas séries de tomadas radiográficas com intervalo de 15 dias entre as séries. Registrou-se em cada série, a posição natural da cabeça (PNC), a PNC acrescida de 5 graus (PNC+5°) e a PNC com flexão de 5 graus (PNC-5°) de cada paciente. Os resultados obtidos demonstraram que as grandezas lineares S-N, ENA-ENP, CO-Gn, Go-Gn, e as grandezas angulares SNA, ANB, PP.GoGn, l.PP, IMPA, 1.1, SN.VER e HF.VER não apresentaram alterações estatisticamente significantes entre as posições estudadas e entre as séries de tomadas radiográficas. As grandezas angulares SNB, SN.GoGn, FMA, SN.PP, Ângulo Z e a grandeza linear Co-Go apresentaram alterações estatisticamente significantes tanto entre as posições quanto entre séries de tomadas radiográficas, porém sem significância do ponto de vista clínico. Concluiu-se que as medidas angulares e lineares avaliadas não apresentaram alterações significantes quando a posição natural da cabeça modificou-se dentro da faixa de variação angular estudada, o que não conduziu a diagnósticos ou interpretações duvidosas. Devido a baixa variação das angulações dos ângulos SN.VER e HF.VER demonstrou-se que a metodologia empregada com a utilização da Unidade Orientadora de Posicionamento, apresentada neste trabalho, permite a reprodutibilidade da posição natural da cabeça com grande confiabilidade dentro de uma faixa de variação da PNC em ± 5°.Abstract: Em 1884, craniologists adopted the Frankfurt horizontal plane, determined by the left Porion, right Porion and left Orbitale points, as being the reference that defines the head position while parallel to the soil. When of the appearance of the cephalometry, countless points, lines and reference planes were used in craniometry, among them the Frankfurt horizontal plane. However, only with the development of the cephalostat, in 1931, the validity of the employment of those references became questioned due to the difficulty of location of the Porion and Orbitale points and to the great variability of individual inclination of that plane which lead to doubtful interpretations when used for cephalometric analyses. Therefore, the Natural Head Position (NHP) associated with an extracranial reference line became object of so much interest for the anthropology as for the orthodontics due to a stable positioning for the evaluations of the facial aesthetics, diagnosis and for the longitudinal study of the craniofacial growth. This work aimed to study the alterations of angular and linear cephalometrics measurements more commonly used in cephalometry, when the natural head position (NHP) is modified during the taking of cephalometric radiography, its intluence in the orthodontic diagnosis, and the reliability and reproducibility of NHP for successive radiographs. One hundred and eighty cephalometrics radiographs were taken in lateral norm of 30 female patients with age range of 21,3 years old. The X-ray were obtained in two series within 15 days interval among them. In each of the series, the natural head position (NHP), the NHP added of 5 degrees (NHP+5°) and NHP with 5 degrees of flexion (NHP-5°) were registered from each patient. The obtained results demonstrated that the linear measurements S-N, ENA-ENP, CO-Gn, Go-Gn, and the angular measurements SNA, ANB, PP. GoGn, I.PP, IMP A, 1.1, SN. VER and HF. VER did not present statistically significant alterations among the studied positions and the two series of radiographic taken as well. The angular measurements of SNB, SN.GoGn, FMA, SN.PP, Z Angle and the linear measurements Co-Go presented statistically significant alterations even between the positions themselves as in the two series of radiographs taken, however, without significance on the clinical point of view. It was concluded that the angular and linear measurements appraised did not present significant alterations when the natural head position modified within of the angular variation strip studied, which did not lead to doubtful diagnosis or interpretations. Due to low variation of the angulations of the SN.VER and HF.VER angles, it was demonstrated that the methodology used with the employment of the Guiding Unit of Positioning presented in this work, allows the reproducibility of the natural head position with great reliability within at 5° variation strip of NHP.MestradoMestre em Ortodonti