Volumetric reconstruction and determination of minimum crosssectional area of the pharynx in patients with cleft lip and palate: comparison between two different softwares

Objective: The aim of this study was to assess the accuracy of volumetric reconstruction of the pharynx by comparing the volume and minimum crosssectional area (mCSA) determined with open-source applications (ITK-Snap, www.itksnap.org ; SlicerCMF) and commercial software (Dolphin3D, 11.8, Dolphin Imaging & Management Solutions, Chatsworth, CA, USA) previously validated in the literature. Material and Methods: The sample comprised of 35 cone-beam computed tomography (CBCT) scans of patients with unilateral cleft lip and palate, with mean age of 29±15. Three-dimensional volumetric models of the pharynx were reconstructed using semi-automatic segmentation using the applications ITK-Snap (G1) and Dolphin3D (G2). Volumes and minimum cross-sectional areas were determined. Inter- and intra-observer error were calculated using ICC test. Comparison between applications was calculated using the Wilcoxon test. Results: Volumes and minimum crosssectional area were statistically similar between applications. ITK-Snap showed higher pharynx volumes, but lower mCSA. Visual assessment showed that 62.86% matched the region of mCSA in Dolphin3D and SPHARM-PDM. Conclusion:Measurements of volume and mCSA are statistically similar between applications. Therefore, open-source applications may be a viable option to assess upper airway dimensions using CBCT exams

Bone-anchored maxillary protraction therapy in patients with unilateral complete cleft lip and palate: 3-dimensional assessment of maxillary effects

The aim of this study was to 3-dimensionally assess the treatment outcomes of bone-anchored maxillary protraction (BAMP) in patients with unilateral cleft lip and palate

Periodontal morphology of teeth moved into grafted alveolar cleft a CBCT assessment

Purpose: the purpose of this research was to assess the periodontal morphology of the canine mesialized to the grafted region in patients with unilateral alveolar clefts with by measuring images of cone- beam computed tomography (CBCT) exams. Methods: the sample comprised CBCT exams of 30 patients with unilateral cleft lip and/or palate during retention period after orthodontic comprehensive treatment. Buccal and lingual alveolar bone thickness of the canine in the clefted side (CF) were measured and compared to the canine (CsF) and lateral incisor in the non-cleft side (IL). To assess the buccal and lingual bone crest height, parassagital slices were obtained passing through the center of the crown of each evaluated teeth. It was calculated the distance form the cemento-enamel junction (CEJ) to the buccal and lingual alveolar bone crest. The comparison among the CF values with the CsF and IL was performed with the paired t test or the Wilcoxon test, depending on the distribution of normality. Results: the results showed that the buccal bone plate is thinner than the lingual bone plate in every tooth evaluated. When comparing the CF and the CsF, there was a statistically significant difference to the buccal alveolar bone thickness (p=0,002). When comparing the CF and IL, there was a statistically significant difference to the buccal alveolar bone thickness (p=0,001) and the lingual bone crest height (p=0,000). Conclusion: the mesialization of teeth to grafted alveolar bone in patients with clefts is a viable option under the periodontal and esthetical perception.FAPES

Avaliação tridimensional da protração ortopédica da maxila com miniplacas em pacientes com fissura labiopalatina

The aim of this study was to assess maxillary, mandibular and glenoid fossa changes after bone anchored maxillary protraction (BAMP) therapy in patients with unilateral complete cleft lip and palate (UCLP). Methods: The experimental group comprised 24 patients with UCLP and maxillary sagittal deficiency with a mean initial age of 11.8 years. Cone-beam computed tomography (CBCT) exams of 24 patients with UCLP taken before (T1) and 18 months (T1) after beginning BAMP therapy were selected from the files of the Hospital of Rehabilitation of Craniofacial Anomalies. CBCTs were superimposed at the cranial base. Three-dimensional displacements of landmarks placed in surface models were quantified and visualized in color-coded maps and semi-transparency superimpositions. Kolmogorov-smirnov test was used to calculate distribution of normality. Paired t test was used to compare cleft and non-cleft sides (p<0.05). Results: A point and non-cleft central incisor displaced toward anterior (1.66mm), inferior (1.21mm) and to the cleft side. Orbitale, Infraorbitale foramen and maxillary first permanent molar displaced similarly toward anterior, inferior and medial direction. The zygoma displaced similarly toward anterior and inferior, however the cleft side showed a significantly greater lateral displacement compared to the non-cleft side. The superior concavity of the glenoid fossa showed symmetrical displacement toward anterior, lateral and superior, while the anterior and posterior eminences showed symmetrical displacements toward anterior, lateral and inferior. The mandible showed an overall symmetrical inferior and posterior displacement except for the medial pole of the condyle, which showed a significantly greater lateral displacement on the cleft side. Conclusions: Maxilla showed an anterior and inferior displacement. The glenoid fossa and the overall mandible symmetrically displaced downward and backward. The zygoma of the cleft side was the only maxillary landmark to show significantly greater lateral displacement than the non-cleft side, as well as the medial pole of the condyle on the cleft side.O objetivo deste trabalho foi avaliar as alterações da maxila, mandíbula e fossa glenóide após o tratamento com protração maxilar ancorada em osso (BAMP) em pacientes com fissura unilateral completa de lábio e palato (UCLP). Métodos: o grupo experimental foi composto por 24 pacientes com UCLP e deficiência sagital de maxila com idade inicial de 11,8 anos. Foram selecionados exames de tomografia computadorizada de feixe cônico (CBCT) de 24 pacientes com fissura UCLP realizadas antes e após 18 meses de terapia com BAMP pertencentes ao Hospital de Reabilitação de Anomalias Craniofaciais. Os exames de CBCT foram sobrepostos pela base do crânio. Deslocamentos tridimensionais foram mensurados por meio de pontos colocados em modelos de superfície, bem como foram visualizados em mapas coloridos e sobreposições de semi-transparência. A distribuição de normalidade foi calculada por meio do teste de Kolmogorov-Smirnov. A comparação entre os lados com e sem fissura foi realizada por meio do teste t pareado (p<0.05). Resultados: O ponto A e o incisivo central superior do lado sem fissura deslocaram para anterior (1.66mm), inferior (1.21mm) e para o lado da fissura. Os pontos Orbitário, Forame Infra-orbitário e os primeiros molares permanentes superiores se deslocaram simetricamente para anterior, inferior e medial. O ponto Zigomático deslocou simetricamente para anterior e inferior, porém o lado da fissura apresentou um deslocamento significantemente maior para lateral comparado ao lado sem fissura. A concavidade superior da fossa glenóide apresentou um deslocamento simétrico para anterior, lateral e superior. As eminências anterior e posterior da fossa glenóide apresentaram um deslocamento simétrico para anterior, lateral e inferior. No geral, não houve diferença estatisticamente significante entre os lados com e sem fissura para o deslocamente inferior e posterior da mandíbula. O polo medial do côndilo foi o único ponto em que o lado da fissura apresentou um deslocamento significantemente maior para lateral quando comparado ao lado sem fissura. Conclusões: A maxila mostrou um deslocamento simétrico para anterior e inferior. A fossa glenóide e a mandíbula mostraram um deslocamento simétrico para inferior e para trás. Entretanto, os pontos zigomático e polo medial apresentaram um deslocamento lateral significantemente maior no lado da fissura

Alveolar bone morphology under the perspective of the computed tomography: defining the biological limits of tooth movement

INTRODUÇÃO: a tomografia computadorizada (TC) permite a visualização do osso alveolar que recobre os dentes por vestibular e lingual. OBJETIVO: o propósito deste estudo foi expor e discutir as implicações da morfologia do osso alveolar, visualizado por meio da TC, sobre o diagnóstico e plano de tratamento ortodôntico. MÉTODOS: foram descritas as evidências sobre a inter-relação entre características dentofaciais e a morfologia das tábuas ósseas vestibular e lingual, assim como evidências sobre a repercussão da movimentação ortodôntica sobre o nível e espessura dessas estruturas periodontais. RESULTADOS: pacientes adultos podem apresentar deiscências ósseas previamente ao tratamento ortodôntico, principalmente na região dos incisivos inferiores. Os pacientes com padrão de crescimento vertical parecem apresentar menor espessura das tábuas ósseas vestibular e lingual no nível do ápice dos dentes permanentes, comparados a pacientes com padrão de crescimento horizontal. O movimento dentário vestibulolingual descentraliza os dentes do rebordo alveolar e ocasiona deiscências ósseas. CONCLUSÃO: a morfologia do rebordo alveolar constitui um fator limitante para a movimentação dentária e deve ser considerada, de forma individual, na realização do plano de tratamento ortodôntico.INTRODUCTION: Computed tomography (CT) permits the visualization of the labial/buccal and lingual alveolar bone. OBJECTIVES: This study aimed at reporting and discussing the implications of alveolar bone morphology, visualized by means of CT, on the diagnosis and orthodontic treatment plan. METHODS: Evidences of the interrelationship between dentofacial features and labial/buccal and lingual alveolar bone morphology, as well as the evidences of the effects of the orthodontic movement on the thickness and level of these periodontal structures were described. RESULTS: Adult patients may present bone dehiscences previously to orthodontic treatment, mainly at the region of the mandibular incisors. Hyperdivergent patients seems to present a thinner thickness of the labial/buccal and lingual bone plates at the level of the root apex of permanent teeth, compared to hypodivergent patients. Buccolingual tooth movement might decentralize teeth from the alveolar bone causing bone dehiscences. CONCLUSION: The alveolar bone morphology constitutes a limiting factor for the orthodontic movement and should be individually considered in the orthodontic treatment planning

Volumetric reconstruction and determination of minimum crosssectional area of the pharynx in patients with cleft lip and palate: comparison between two different softwares

Abstract Objective: The aim of this study was to assess the accuracy of volumetric reconstruction of the pharynx by comparing the volume and minimum crosssectional area (mCSA) determined with open-source applications (ITK-Snap, www.itksnap.org ; SlicerCMF) and commercial software (Dolphin3D, 11.8, Dolphin Imaging & Management Solutions, Chatsworth, CA, USA) previously validated in the literature. Material and Methods: The sample comprised of 35 cone-beam computed tomography (CBCT) scans of patients with unilateral cleft lip and palate, with mean age of 29±15. Three-dimensional volumetric models of the pharynx were reconstructed using semi-automatic segmentation using the applications ITK-Snap (G1) and Dolphin3D (G2). Volumes and minimum cross-sectional areas were determined. Inter- and intra-observer error were calculated using ICC test. Comparison between applications was calculated using the Wilcoxon test. Results: Volumes and minimum crosssectional area were statistically similar between applications. ITK-Snap showed higher pharynx volumes, but lower mCSA. Visual assessment showed that 62.86% matched the region of mCSA in Dolphin3D and SPHARM-PDM. Conclusion: Measurements of volume and mCSA are statistically similar between applications. Therefore, open-source applications may be a viable option to assess upper airway dimensions using CBCT exams