Manifestaciones craneofaciales en pacientes con osteodistrofia renal / Craneofacial manifestaciones in patients with renal osteodystrophy

Introducción: La osteodistrofia renal es una osteopatía metabólica difusa, relacionada con la insuficiencia renal crónica, que incluye diversas patologías en el sistema musculoesquelético. Se produce en respuesta a trastornos metabólicos generados por cambios electrolíticos, la inflamación crónica y la alteración hormonal. Estas variaciones modifican el proceso de remodelación ósea. Las manifestaciones clínicas incluyen alteración en el parénquima y estroma óseo, y van desde lesiones expansivas, produciendo deformidad, hasta fracturas patológicas del hueso. Objetivo: Relacionar las manifestaciones clínicas, imagenológicas e histológicas en el componente óseo cráneo facial para el diagnóstico de la osteodistrofia renal. Presentación de caso: Se presentan dos casos clínicos de pacientes con enfermedad renal crónica e hiperparatiroidismo secundario de base, con múltiples masas en maxilares que causan asimetría facial y alteración funcional. Las imágenes tomográficas revelan alteración en la morfología ósea cortical y trabecular. Ambos individuos evidenciaron alteraciones en niveles de hormona paratiroidea, fosfatasa alcalina, fósforo y calcio sérico. La histopatología comprobó tejido fibroóseo con hueso neoformado y gran vascularización, con células multinucleadas tipo osteoclastos sin presencia de hemosiderina. Pacientes manejados de forma interdisciplinaria entre medicina interna, endocrinología y cirugía maxilofacial. Conclusiones: Los pacientes con enfermedad renal crónica avanzada presentan alteración de la estructura y del metabolismo óseo y mineral. Tal situación puede comprometer el complejo óseo craneofacial. Los casos graves de osteodistrofia renal se caracterizan por una marcada expansión de los maxilares, que genera asimetría y rasgos de leontiasis. Las imágenes tomográficas asociadas a osteodistrofia renal presentan óseos trabeculares con expansión de cortical, que evidencia el recambio óseo inmaduro presente. La histopatología no es específica y puede ser similar a los casos de displasia ósea craneofacial. Ante lo anteriormente planteado es fundamental relacionar estos hallazgos con la clínica para definir un diagnóstico adecuado(AU)

(AU)Introduction: Renal osteodystrophy is a diffuse metabolic osteopathy, related to chronic renal failure, which includes various pathologies in the musculoskeletal system. It occurs in response to metabolic disorders generated by electrolyte changes, chronic inflammation and hormonal alteration. These variations modify the process of bone remodeling. Clinical manifestations include alteration in the parenchyma and bone stroma, and range from expansive lesions, producing deformity, to pathological fractures of the bone. Objective: Relate the clinical, imaging and histological manifestations in the skull-facial bone component for the diagnosis of renal osteodystrophy. Case Presentation: Two clinical cases of patients with chronic kidney disease and secondary underlying hyperparathyroidism are presented, with multiple masses in the jaws that cause facial asymmetry and functional alteration. Tomographic images reveal alteration in cortical and trabecular bone morphology. Both individuals showed alterations in levels of parathyroid hormone, alkaline phosphatase, phosphorus and serum calcium. Histopathology verified fibro-bone tissue with neoformed bone and great vascularization, with multinucleated osteoclast-like cells without the presence of hemosiderin. Patients were attended in an interdisciplinary way between internal medicine, endocrinology and maxillofacial surgery. Conclusions: Patients with advanced chronic kidney disease present alteration of the structure and bone and mineral metabolism. Such a situation can compromise the craniofacial bone complex. Severe cases of renal osteodystrophy are characterized by a marked expansion of the jaws, which generates asymmetry and traits of leonthiasis. The tomographic images associated with renal osteodystrophy present trabecular bones with cortical expansion, which evidences the immature bone turnover present. Histopathology is not specific and may be similar to cases of craniofacial bone dysplasia. Given the above, it is essential to relate these findings to the clinic to define an adequate diagnosis(AU)

Biología del tejido óseo y cambios morfológicos en su regeneración / Biology of bone tissue and morphological changes in its regeneration

Introducción: La regeneración ósea permite la reintegración y conformación de tejidos posteriores a la extracción o corrección de un defecto óseo. Es considerada una técnica de estimulación para la formación de hueso nuevo, donde se favorece la construcción y la preservación del coágulo con el fin de evitar la infiltración en la zona de reparación, de componentes celulares (células epiteliales y conjuntivas). Objetivos: Describir los cambios a nivel morfológico durante el proceso de regeneración ósea y mencionar distintas técnicas de preservación ósea y los factores necesarios para su realización. Presentación de caso: Paciente femenina con periodontitis apical asintomática en órganos dentarios 34 y 37, que se sometió a preservación alveolar mediante la práctica de exodoncia atraumática y regeneración ósea con xenoinjerto, colocación de membrana colágeno e implante posextractivo inmediato. Principales comentarios: La colocación inmediata de implantes posexodoncia permite una buena preservación del alveolo, siempre y cuando las condiciones clínicas del paciente así lo permitan, por ejemplo, la ausencia de procesos infecciosos agudizados como en el presente caso. La regeneración ósea, en el defecto producido por el proceso inflamatorio periapical, implicó una correcta detoxificación de la zona a través del curetaje y la aplicación de antibióticos. La respuesta inmunológica exagerada ante injertos óseos no es frecuente; sin embargo, en este caso llevó a una pérdida parcial del sustituto óseo sin comprometer el pronóstico de los implantes(AU)

Introduction: Bone regeneration allows the reintegration and conformation of tissues after the extraction or correction of a bone defect. It is considered a stimulation technique for the formation of new bone, where the construction and preservation of the clot is favored in order to avoid infiltration in the repair area of cellular components (epithelial and conjunctiva cells). Objective: Describe the changes at the morphological level during the bone regeneration process and mention different bone preservation techniques and the necessary factors for their implementation. Case presentation: Female patient with asymptomatic apical periodontitis in dental organs 34 and 37, who underwent alveolar preservation through the practice of atraumatic exodontics and bone regeneration with xenograft, collagen membrane placement and immediate post-extraction implant. Main comments: The immediate placement of post-exodontic implants allows a good preservation of the alveolus, as long as the clinical conditions of the patient allow it, for example, the absence of exacerbated infectious processes as in the present case. Bone regeneration, in the defect produced by the periapical inflammatory process, involved a correct detoxification of the area through curettage and the application of antibiotics. Exaggerated immune response to bone grafts is not common; however, in this case it led to a partial loss of bone substitute without compromising the prognosis of the implants(AU)

Abordaje quirúrgico para verticalización de tercer molar a través de minitornillo. ¿es necesaria la extracción? / Surgical approach for the verticalization of the third molar through a miniature screw. Is extraction necessary?

RESUMEN Anteriormente se reportaba en la literatura que terceros molares en mala posición como horizontales, mesio y disto angulados, era indicación clara para la extracción del diente. La verticalización de molares con minitornillo en la rama mandibular, corresponde a una técnica ortoquirúrgica en la cual a través de movimientos sobre el eje longitudinal de un diente, se logra un buen posicionamiento en la arcada y la preservación del diente, evitando la extracción. El propósito del trabajo es describir el abordaje quirúrgico y resultados, de la verticalización de un tercer molar inferior incluido en posición mesioangular, a través de la colocación de minitornillo utilizando la rama mandibular como anclaje de un paciente femenino de 35 años de edad.

ABSTRACT Previously, it was reported in the literature that third molars in poor position, such as horizontal, mesial and disto angulated, were a clear indication for tooth extraction. The verticalization of molars with a miniscrew in the mandibular branch corresponds to an ortho-surgical technique in which, through movements on the longitudinal axis of a tooth, a good positioning in the arch and preservation of the tooth is achieved, avoiding extraction. The purpose of this work is to describe the surgical approach and results of the verticalization of an included lower third molar in the mesioangular position, through the placement of a miniature screw using the mandibular branch as anchorage in a 35-year-old female patient.

Exclusión renal por endometriosis profunda ureteral: a propósito de un caso / Renal exclusion due to deep infiltrating ureteral endometriosis: a case report

INTRODUCCIÓN: La endometriosis ureteral es una afección rara que afecta al 0.01-1,7% de las mujeres con endometriosis. Hasta un 30% cursa de forma asintomática y un 11,5-14,7% pueden evolucionar con falla renal. La falta de diagnóstico de la enfermedad puede terminar en una uropatía obstructiva y falla renal irreversible. Se presenta el caso de una paciente con afectación grave de la función renal secundaria a endometriosis profunda con compromiso ureteral. CASO CLÍNICO: Mujer de 35 años con endometriosis que consultó por exacerbación de los síntomas. En su estudio destaca, en la resonancia magnética, el hallazgo de endometriosis pélvica profunda y compromiso endometriósico intrínseco del uréter distal derecho, provocando una acentuada hidroureteronefrosis. El cintigrama renal demuestra acentuado compromiso de la función renal derecha, con una función relativa del 7%. Se realizaron nefrectomía total derecha y resección de enfermedad pélvica profunda laparoscópica, sin incidentes. CONCLUSIONES: La endometriosis ureteral representa un desafío diagnóstico y terapéutico. El manejo multidisciplinario entre radiólogos, ginecólogos y urólogos, mediante el diseño de una estrategia quirúrgica individualizada, es imprescindible para definir el tratamiento óptimo de estas pacientes.

INTRODUCTION: Ureteral endometriosis is a rare entity that affects 0.01-1,7% of women with endometriosis. Up to 30% of the patients are asymptomatic and 11.5-14.7% will develop renal failure. Misdiagnosis can lead to obstructive uropathy and permanent renal failure. We present the case of a patient with severe compromise of renal function secondary to deep infiltrating endometriosis with ureteral involvement. CASE REPORT: A 35-year-old woman with endometriosis presented with exacerbation of symptoms. Magnetic resonance showed deep pelvic endometriosis and intrinsic endometriotic involvement of the right distal ureter, causing a marked hydroureteronephrosis. Renal scintigram showed a severe compromise of the right renal function, with a relative function of 7%. Through laparoscopy a total right nephrectomy and resection of deep infiltrating endometriosis was performed. The patient had a satisfactory recovery in the postoperative period. CONCLUSIONS: Ureteral endometriosis presents a diagnostic and therapeutical challenge. Joint multidisciplinary management between radiologists, gynecologists and urologists through the design of an individualized surgical strategy is essential to define the optimal treatment for these patients.

Covid-19 y cirugía ortopédica: revisión de la literatura y evidencias / Covid-19 and orthopedic surgery: review of the literature and evidence

Se ha declarado una pandemia ante la propagación de un nuevo virus con alta contagiosidad, llamado síndrome respiratorio agudo severo coronavirus 2 (severe acute respiratory syndrome coronavirus 2, SARS-CoV2). El mundo ha quedado detenido ante la rápida expansión del virus, con una letalidad que en algunos países llega a 15%. En Chile, el gobierno ha tomado medidas rápidas y agresivas que han permitido mantener la curva de contagios a un nivel que permita atender de manera adecuada a la población. Dentro de estas medidas, se contempla la suspensión de cirugías y consultas ambulatorias. Como cirujanos ortopédicos, nos hemos visto afectados por estas medidas, y existe confusión respecto a cuál es la conducta más adecuada. Quisimos hacer esta guía para resumir parte de las evidencias disponibles y orientar a los cirujanos ortopédicos respecto a esta patología. El comportamiento de esta guía es dinámico, dadas las múltiples opiniones, experiencias y evidencias, que surgen diariamente, por lo que recomendamos mantenerlo como referencia, no como certeza.

A pandemic has been declared due to a new highly contagious virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). The world has come to a halt due to the rapid expansion of a virus whose lethality has reached 15% in some countries. In Chile, the government has taken decisive, aggressive measures in an attempt to control disease spread and provide healthcare to those who need it. These decisions include the suspension of elective surgeries and other ambulatory procedures. As Orthopedic surgeons we have been affected by these measures and there is doubt regarding the best course of action. We prepared this guide to summarize available evidence and orient our colleagues regarding this pathology. This guide is meant to be dynamic, as new opinions, evidence and experiences arise every day. Therefore, we advise the reader to keep it as a reference, not an undisputable truth.

Hipertensión y obesidad en niños de un centro de educación preescolar de la ciudad de Popayán­Colombia: Un estudio descriptivo / Hypertension and obesity in children of a pre-school education center in the city of Popayán-Colombia: A descriptive study

Objetivo: el objetivo de la presente investigación es describir la prevalencia de hipertensión y obesidad, como factores de riesgo cardiovascular en niños pertenecientes a un centro de educación preescolar la ciudad de Popayán- Colombia. Materiales y métodos: Estudio descriptivo, de corte transversal. Se estimaron medidas antropométricas y de presión arterial en 45 preescolares. Resultados: la obesidad, de acuerdo a IMC, se presentó en un 11.1% de los preescolares, mientras que 6.6% de los individuos evaluados tuvieron mediciones de tensión arterial sistólica o diastólica, en rango de hipertensión arterial. Conclusiones: los hallazgos de la presente investigación sugieren que la aparición de factores de riesgo para la enfermedad cardiovascular, tiene lugar en edades muy tempranas. La generación de hábitos saludables podría prevenir la aparición y persistencia de dichos factores..(AU)

Objective: the aim of current investigation is to describe the prevalence of hypertension and obesity, as the cardiovascular risk factors in children belonging to a pre-school education center in the City of Popayán- Colombia. Materials and methods: Descriptive, cross-sectional study. Anthropometric measurements and blood pressure were estimated in 45 preschoolers. Results: obesity, according to IMC, was presented in 11.11% of the preschool children, while 6.66% of the individuals evaluated had blood pressure, systolic or diastolic blood pressure in the range of arterial hypertension. Conclusions: the findings of the present investigation suggest that the appearance of risk factors for cardiovascular disease occurs at very young ages. The generation of healthy habits could prevent the appearance and persistence of these factors..(AU)

Manejo odontológico de pacientes con el síndrome de Christ-Siemens-Touraine. Reporte de un caso / Dental handling of patients with Christ-Siemens-Touraine syndrome. Case report

Resumen La displasia ectodérmica (DE) comprende un grupo de trastornos hereditarios en los que dos o más estructuras derivadas del ectodermo se encuentran afectadas. Los pacientes con este trastorno presentan hipoplasia o aplasia de estructuras como la piel, el cabello, uñas, dientes, glándulas sudoríparas y otras estructuras. El manejo odontológico es fundamental para mejorar la calidad de vida del individuo. Se reporta el caso de un paciente masculino con síndrome Christ-Siemens-Touraine, quien asistió a consulta por anodoncia de órganos dentarios en maxilar superior e inferior, se realizó un abordaje odontológico que involucró periodoncia, rehabilitación oral e implantología y acompañamiento social, dirigido a restablecer funcionalidad y estética del sistema estomatognático. Con el tratamiento realizado se obtuvo mejoría absoluta en el proceso de masticación y una sonrisa estética satisfactoria para el paciente y su representante legal.

Abstract Ectodermal dysplasia (ED) encompasses a group of hereditary disorders in which two or more ectoderm-derived structures are affected. Patients afflicted with this disorder exhibit hypoplasia or aplasia of different structures such as skin, hair, nails, teeth, and sweat glands among others. Dental treatment is of the utmost importance in order to improve the subject's quality of life. The case here reported depicts a male patient affected with Christ-Siemens- Touraine syndrome, who sought treatment due to tooth anodontia in upper and lower jaws. A dental approach was conducted involving periodontal treatment, oral rehabilitation and implantology, a social component was also furthered, directed to re-establish function and esthetics of the stomatognatic system. Performed treatment achieved absolute improvement in the masticatory process and esthetic smile which was satisfactory for the patient and his legal representative.

Escherichia Coli productora de Nueva Delhi metalo-ß-lactamasa en Colombia: reporte de caso / Escherichia Coli producing New Delhi metallo-ß-lactamase in Colombia: A case report

Notificamos un caso de infección por Escherichia coli productora de Nueva Delhi metalo-b-lactamasa (NDM) en un paciente que desarrolló un absceso subcapsular hepático como complicación de una colecistectomía laparoscópica. La NDM es una carbapenemasa adquirida tipo Ambler B, que confiere resistencia a todos los b-lactámicos, excepto al aztreonam, aunque existen reportes de resistencia a este último. En Colombia, la primera descripción de cepas productoras de NDM se realizó en aislamientos de Klebsiella pneumoniae en una unidad de cuidados intensivos neonatales en Bogotá. Desde entonces se han realizado reportes de distintas cepas, siendo esta la primera reportada en el país relacionada con Escherichia coli productora de NDM.

We report a case of infection by New Delhi metallo-β-lactamase (NDM)-producing Escherichia coli in a patient who developed a subcapsular hepatic abscess as a complication of laparoscopic cholecystectomy. NDM is an acquired carbapenemase Ambler class B, which confers resistance to all b-lactams except aztreonam, although there are reports of resistance to the latter. In Colombia, the first report of NDM-producing strains was made on isolates of Klebsiella pneumoniae in a neonatal intensive care unit in Bogota. There have since been reports of different strains, marking the first reported in the country of NDM-producing Escherichia coli.

Correlación en el diagnóstico clínico, radiográfico e histológico de lesiones apicales dentales / Correlation of clinical, radiographic and histological diagnoses of apical dental lesions

Objetivo: Establecer la correlación entre las características clínicas, radiográficas e histológicas de lesiones apicales dentales al momento de su diagnóstico. Material y métodos: Estudio descriptivo en el que se realizó la comparación de las características clínico-radiográficas con el estudio histopatológico de las lesiones. Se incluyeron muestras de individuos que fueron diagnosticados con procesos de patología periapical, obtenidas a través de apicectomías y extracciones dentales. Los cortes fueron procesados rutinariamente y evaluados por patólogo para su diagnóstico histológico. Resultados: El 50% de las muestras fue diagnosticado como periodontitis apical, seguido por quistes periapicales (28.5%). Al correlacionar entre sí características clínicas como sensibilidad a la percusión y dolor espontáneo hubo asociación (p = 0.01). Igualmente, al relacionar la pérdida ósea vertical con movilidad dental (p = 0.023) y ésta con el órgano dentario afectado (p = 0.036). Sin embargo, no mostró asociación, la correlación entre el estado sintomático del paciente como dolor espontáneo y el tipo de infiltrado inflamatorio predominante en las lesiones (p = 1.4); pero sí la hubo, con el tipo de infiltrado secundario que existía en ellas (p = 0.057). La movilidad dental se mostró como un marcador diagnóstico para granuloma y quiste periapical (p = 0.025). Conclusiones: Se hallaron ciertos marcadores clínicos capaces de predecir la presentación histológica de las lesiones, como la movilidad dental para granuloma y quiste periapical. Sin embargo, la predicción exacta de cada una de las patologías aún se hace difícil, debido a la misma dinámica de las lesiones y a la poca correlación que existe entre las características clínico-radiográficas con la descripción histológica de las lesiones.

Objective: To establish a correlation amongst clinical, radiographic and histological characteristics of dental apical lesions at the time of diagnosis. Material and methods: A descriptive study which undertook to establish comparison of clinical and radiographic characteristics with histopathological study of lesions. Included in the study were samples of individuals which had been previously diagnosed with periapical disease processes; samples were harvested from apicoectomies and dental extractions. In order to achieve histological diagnosis, a pathologist routinely processed and assessed all specimens. Results: 50% of all samples were diagnosed as apical periodontitis, followed by periapical cysts (28.5%). An association of (p = 0.01) was found when correlating clinical characteristics such as sensitivity to percussion and spontaneous pain. The same situation arose when relating vertical bone loss to dental mobility (p = 0.023), and dental mobility with affected tooth (p = 0.036), nevertheless, no association was found with correlation of patient's symptomatic status, such as spontaneous pain, and type of predominant inflammatory infiltrate in the lesions (p = 1.4), nevertheless, association was found with the secondary infiltrate type existing in them (p = 0.057). Dental mobility was taken as diagnostic marker for granuloma and periapical cyst (p = 0.025). Conclusions: Certain clinical markers were found with the ability to predict histological manifestation of the lesions, such as dental mobility for granuloma and periapical cyst cases. Nevertheless, exact prediction of each one of the diseases is still dificult to obtain, this is due to the lesion's dynamics and the scarce correlation existing among clinical and radiographic characteristics with the histological description of the lesions.

Influência da Resina para Colagem na Resistência ao Cisalhamento de Bráquetes ao Esmalte Bovino / Influence of Composite Resin on the Shear Bond Strength of Brackets to Bovine Enamel

Objetivou-se avaliar a resistência da união ao cisalhamento (RC) de bráquetes metálicos colados ao esmalte bovino com as resinas compostasConcise (3M), Alpha Plast (DFL), Transbond XT (3M) e Orthocem (FGM) e verificar o índice de remanescente de adesivo (IRA). Foram utilizados 80 incisivos bovinos recém-extraídos e com coroas sem falhas. As coroas foram separadas das raízes, embutidas em tubos de PVC com resina de poliestireno e distribuídas em 4 grupos (n=20). Foi realizada profilaxia na face vestibular dos dentes, condicionamento com ácido fosfórico 37% e colagem de bráquetes seguindo as orientações dos fabricantes para cada grupo de resina (G1-Concise (3M); G2-Alpha Plast (DFL); G3-Transbond XT (3M); G4-Orthocem (FGM)). As amostras foram armazenadas em água destilada a 37 ºC por 24h e submetidas ao ensaio de resistência ao cisalhamento em máquina universal de ensaios mecânicos Instron à velocidade de 1mm/min. Após a falha, o IRA foi verificado em lupa estereoscópica com magnificação de 40x. Os dados em MPa foram avaliados pela Análise de Variância um fator e teste de Tukey, em nível de significância de 5%. Houve diferença significativa entre as resinas (p<0,001), sendo que RC (MPa) de Transbond XT (20,0), Alpha Plast (18,4) e Concise Ortodôntico (17,6) foi significativamente maior (p<0,05) que Orthocem (12,7). O IRA mostrou que para todas as resinas houve predominância de ruptura total da interface resina-dente (escore 0). Concluiu-se que as resinas que utilizam adesivo previamente à colagem apresentaram os maiores valores de resistência, embora todos os grupos mostrassem valores clinicamente aceitáveis.

The aim of this study was to evaluate the shear bond strength (SBS) of metal brackets bonded to bovine enamel with composite resin Concise (3M), Alpha Plast (DFL), Transbond XT (3M) and Orthocem (FGM), and check the adhesive remnant index (ARI). Eighty freshly extracted bovine incisors with flawless crowns were used. The crowns were separated from roots, PVC pipes embedded in polystyrene resin and divided into 04 groups (n=20). Prophylaxis was performed on the facial surface of teeth, etched with phosphoric acid at 37% and bracket bonding according to the manufacturers? guidelines (G1 - Concise (3M), G2 - Alpha Plast (DFL), G3 - Transbond XT (3M), G4 - Orthocem (FGM)). The samples were stored in distilled water at 37 °C for 24 h and subjected to the shear strength in the universal testing machine Instron at 1mm/ min. After the failure, the ARI was observed in a stereomicroscope with 40x magnification. Data were evaluated in MPa by one-factor ANOVA and Tukey?s test at 5% a significance level. Difference between the resins (p<0.001), and SBS (MPa) of Transbond XT (20.0), Alpha Plast (18.4) and Concise (17.6) was significantly higher (p<0.05) than Orthocem (12.7). According to ARI, a predominance of adhesive failures between the resin and the tooth (score 0) was observed for all resins. It was concluded that the resins using adhesive prior to bonding showed the highest resistance values, although all groups exhibited clinically acceptable values.

Force decay in orthodontic elastomeric chains after immersion in disinfection solutions

Aim: To evaluate the force decay of orthodontic elastomeric chains after immersion in disinfecting solutions. Methods: One-hundred and fifty segments of elastomeric chains were divided in 3 groups: Control group - no disinfection; Chlorhexidine group - disinfection in 0.12% chlorhexidine digluconate solution; and Peracetic acid group - disinfection in 0.2% peracetic acid solution. Elastomeric chains of 14 mm were stretched up to 20 mm and the given force (kgf) was evaluated in an Instron universal testing machine at the following intervals: 1 h, 1 day, 7, 14, 21 and 28 days after the immersion in the disinfecting solutions. Data (kgf) were analyzed statistically by Analysis of Variance and Tukey's test at a 5% significance level. Results: Both groups presented similar force decay along 7 days and remained stable up to 28 days. Force degradation was observed in the first hours of activation (~50%). Conclusions: It may be concluded that there were no significant differences among the investigated groups, in most interval times, indicating that both chemical solutions can be used for previous disinfection of orthodontic elastomeric chains.

Avaliação comparativa da percepção de diferentes profissionais em Ortodontia no diagnóstico do perfil facial / Comparison evaluation of different perception of orthodontists in the diagnosis of facial profile

O objetivo deste estudo foi avaliar a concordância de diagnóstico considerando a classificação de perfis faciais, realizada por dentistas em diferentes níveis de programas de pós-graduação em Ortodontia. Um total de 30 fotografias digitais da face, em norma frontal e lateral, foi utilizado no estudo. As fotografias foram analisadas por três ortodontistas calibrados que, baseados em características morfológicas, classificaram os perfis faciais nos seguintes padrões: I, II, III, face curta e face longa, de acordo com Capelozza (2004). Com o objetivo de verificar a influência do nível educacional na taxa de concordância de diagnóstico facial das 30 fotografias, 15 foram randomicamente selecionadas e submetidas à análise. Os três diferentes níveis avaliados de dentistas de programas de pós-graduação em Ortodontia foram: atualização; especialização e mestrado. Os dados foram submetidos à análise do coeficiente kappa e qui-quadrado (a=0,05). Não houve diferença estatística entre a concordância alcançada pelos diferentes grupos em comparação ao padrão-ouro (p=0,8441). Contudo, interessantemente, houve maior concordância no grupo de especialização (K=0,362 e p-valor < 0,001). Mesmo com as limitações inerentes a este tipo de análise, concluiu-se que os profissionais dos diferentes níveis de aprendizado determinaram diagnósticos semelhantes em relação ao mesmo paciente, e que os especialistas apresentam maior concordância no diagnóstico.

The aim of this study was to evaluate the diagnosis concordance regarding the classification of facial profiles realized by dentists in the different levels of post-graduation Orthodontic courses. A total of 30 digital photographs of the face, in frontal and lateral views, were used in this study. The photographs were analyzed for 3 calibrated orthodontists who, based on morphological characteristics presented in the images, classified the facial profiles in the following patterns: I, II, III, short-face and long-face, according Capelozza (2004). In order to verify the influence of educational level on the agreement rate regarding facial diagnosis, from the 30 photographs, 15 were randomly selected and subjected to analysis. The different evaluated degree levels of dentists under post-graduation programs in Orthodontic were: training, specialization and mastering. Data were subjected to kappa coefficient and chi square analysis (a=0.05). There was no statistical differences in the agreement achieved by the different groups in comparison with the gold standard (p=0.8441). However, interestingly, there was a higher accordance in the specialization group (K=0.362 e p < 0.001). Within the limitations inherent to this type of analyse, we conclude that the professionals in the different levels of degree determined similar diagnostics regarding a singular patient. Moreover, the specialization group presented higher concordance in the diagnosis.

Cirurgia ortognática: uma visão contemporânea / Orthognathic surgery: a contemporary view

O objetivo deste artigo foi descrever fatores necessários para o correto planejamento ortodôntico-cirúrgico. A cirurgia ortognática pode ser um importante recurso para o restabelecimento das estruturas e funções do sistema estomatognático. O planejamento dos casos deve privilegiar igualmente fatores como oclusão, estética, via aérea, estabilidade articular, mastigação, fonoarticulação e deglutição. Diagnóstico e trabalho em equipe entre o ortodontista e o cirurgião são necessários para a obtenção de resultados previsíveis e de acordo com as expectativas do paciente.

The aim of this study was to describe factors needed for proper planning orthodontic surgery Orthognathic surgery may be an important tool for reestablishment of structures and functions in stomatognathic system. Planning cases should also favoring factors such as occlusion, aesthetics, upper airway, joint stability, chewing, speech disorders and swallowing. Diagnosis and teamwork among orthodontist and surgeon are needed to achieve predictable results and according to the patient's expectations.

Interação Ortodontia e cirurgia bucomaxilofacial no tratamento de deformidades dentofaciais / Orthodontics and maxillofacial surgery in dentofacial abnormalities

O desenvolvimento das bases ósseas maxilomandibulares fora do padrão de normalidade pode ocasionar alterações dentofaciais, muitas vezes, impossíveis de serem corrigidas exclusivamente pela Ortodontia convencional. Em muitos casos, o tratamento das deformidades dentofaciais somente é possível por meio da união de esforços entre Ortodontia e cirurgia bucomaxilofacial, uma vez que é realizado e conduzido em conjunto por dois profissionais. O diagnóstico e o planejamento ortodôntico cirúrgico devem ser realizados por esses profissionais em equipe, desde a consulta inicial até a finalização ortodôntica, para obter os melhores resultados estéticos e funcionais. A interação entre estes profissionais pode ser a chave do sucesso desses casos. O objetivo deste artigo foi informar conceitos técnicos que devem ser observados pelo ortodontista durante todas as fases ortodônticas desse tratamento.

The abnormal maxillomandibular development can cause dentofacial changes, often impossible to be corrected using only conventional orthodontics. Many cases dentofacial deformities treatment is possible only through team efforts among orthodontics and oral maxillofacial surgery, since it is performed and conducted jointly by these two profissionals. The orthodontic diagnosis and surgical planning should be performed by these professionals on staff, from starting to end orthodontics treatment for best aesthetic and functional results. The interaction among these professionals may be the key to the success of these cases. This article aims to inform technical concepts that must be observed by the orthodontist during all stages of orthodontic treatment.

Prevalência das fissuras labiopalatinas na cidade de Rio Claro - SP dos anos de 2006 a 2009 / Prevalence of lip and palate cleft in Rio Claro - SP, from 2006 to 2009

Diante do aumento da prevalência de fissurados na região sudeste, este estudo buscou identificar, dentre os nascidos vivos da cidade de Rio Claro - SP, esse aumento. Foi realizada uma investigação nos prontuários pertencentes à Vigilância Sanitária da cidade de Rio Claro-SP, no período de janeiro a novembro de 2006 a 2009, com a finalidade de verificar, dentre o número total de recém-nascidos vivos, a porcentagem de recém-nascidos com a presença de fissuras. Em 9129 prontuários de pacientes nascidos na região de Rio Claro - SP, foi verificada a ocorrência de fissura labial ou palatina, relacionada com o sexo. Os dados obtidos foram submetidos a uma estatística descritiva. Diante dos resultados, foi possível concluir que o registro da prevalência de pacientes fissurados na região sudeste do Brasil tem aumentado e que as fendas labiais foram mais prevalentes no sexo masculino e as palatinas no feminino.

Given the increased prevalence of cleft in the Southeast, this study intent to identify, among the living babies that were born in Rio Claro - S.P, the assurance of this prevalence. An investigation in the precedent handbooks from the Health Surveillance in Rio Claro - S.P, since January 2006 until November 2009, comes to verify the percentage of living new-born that presents with cleft. Occurrences of lip and palate clefts and sex were confirmed in 9129 handbooks from patients born in Rio Claro. The data obtained were submitted to a descriptive statistic. It was possible to conclude by the results that record of the prevalence of cleft patients in the Southeast region of Brazil has increased and lip clefts are more predominant in male and palate clefts in female people.

Fracture strength of ceramic brackets submitted to archwire torsional strain

Aim: To evaluate the fracture strength of ceramic brackets submitted to archwire torsional strain. Methods: Different types of maxillary central incisor ceramic brackets from four different commercial brands, Roth prescription (0.022" x 0.028"), were evaluated, namely: Mystique (GAC), InVu (TP Orthodontics), Clarity (3M Unitek) and Luxi II (RMO Ortohodontics). To evaluate the fracture strength, 0.019"x 0.025" stainless steel orthodontic wires were inserted into the bracket channels and submitted to torsion until they fractured. Results: The InVu brackets showed a significantly higher fracture strength than the other brackets (p<0.05), which did not differ significantly among them (p>0.05). Conclusions: Among the brackets tested, the traditional ceramic bracket InVu showed the highest fracture strength, while the Luxi II bracket, obtained the lowest value.

Posição do incisivo inferior em pacientes braquifaciais e sua correlação com a maloclusão Classe I, II e III esquelética / Lower incisor position in brachyfacial patients its correlation with malocclusion Class I, II and III skeletal

Objetivo: Avaliar cefalometricamente a posição dos incisivos inferiores em indivíduos braquifaciais nas maloclusões de Classe I, II e III, assim como sua correlação. Métodos: A amostra constou de 60 telerradiografias de cabeça tomadas em norma lateral com imagens de qualidade e nitidez adequada, pertencentes a documentações de pacientes adultos, de ambos os sexos, portadores de dentição permanente completa e não submetidos a tratamento ortodôntico prévio. Resultados: As mensurações para análise da posição do incisivo inferior foram obtidas através das grandezas que caracterizam a posição de incisivo inferior, a saber: 1.NB, FMIA, IMPA, DC (Discrepância Cefalométrica de Tweed). Os dados foram submetidos à análise estatística de Kruskal-Wallis p<0,05 e ao Teste de correlação de Spearman considerando cada medida em função das maloclusões. Conclusão: Há correlação direta das discrepâncias esqueléticas com o posicionamento dos incisivos inferiores em indivíduos braquifaciais, e quando maior a Classe II maior a tendência de vestibularização do incisivo inferior, e quanto maior a Classe III maior a tendência de lingualização desses dentes.

Objective: The purpose of this study was to perform a cephalometric evaluation of the mandibular incisor position and its correlation with Class I, II and III malocclusions in individuals with a brachyfacial pattern. Methods: The sample consisted of 60 lateral teleradiographs of the head, with images of good quality and clarity from the documentation of adult patients of both genders, with complete permanent dentition, who had not previously been submitted to orthodontic treatment. Results: The measurements for analyzing the mandibular incisors were obtained by means of the variables that characterize the mandibular incisor position, namely: 1.NB, FMIA, IMPA, DC (Tweed?s Cephalometric Discrepancy). The data were submitted to statistical analysis using the Kruskal-Wallis test p<0,05 and Spearman?s correlation test considering each measurement as a function of the malocclusions. Conclusion: It was concluded that there is direct correlation of skeletal discrepancies with the lower incisors positioning in individuals brachyfacial, and therefore the greater the Class II greater the tendency for flaring of the lower incisor, and the higher the class III greater the tendency for these teeth lingually.

Distalização de molares utilizando miniparafusos ortodônticos / Molar distalization with the use of orthodontic mini-screws

Este artigo ilustra a correção da má oclusão de Classe II de Angle, de natureza dentoalveolar, em um paciente com desvio da linha média superior, utilizando miniparafusos ortodônticos. Estratégias diferenciadas foram empregadas, em cada lado, para corrigir a Classe II assimétrica. No lado com necessidade de maior movimentação a distalização foi feita em duas etapas. Primeiro, a distalização dos molares empregando um cursor e depois a retração dos dentes anteriores. Neste lado foram utilizados dois miniparafusos. Do outro lado, com menor necessidade de distalização, foi efetuada a retração dos dentes anteriores juntamente com a distalização dos molares em uma única fase. Esta abordagem reduz o número de extrações de pré-molares, utilizando uma mecânica simples e eficiente, sem efeitos colaterais indesejados. Os miniparafusos ortodônticos vêm sendo cada vez mais utilizados como dispositivo de ancoragem no tratamento da Classe II, pois este recurso não depende da colaboração do paciente, tornando os tratamentos mais previsíveis.

This article illustrates the correction of Angle’s dentoalveolar Class II malocclusion in a patient with superior midline deviation, by means of orthodontic mini-screws. Diverse strategies were applied to each side in order to correct the assimetric Class II. On the side requiring more movement, distalization was accomplished in two phases. First, the molar distalization with the use of a cursor and after the anterior teeth retraction. On that side, two mini-screws were used. On the other side, which needed less distalization, the retraction of the anterior teeth was performed along with the molar distalization, in a single phase. This approach reduces the number of premolar extractions, as it makes use of simple and efficient mechanics with no undesirable side effects. The orthodontic mini-screws have been most often used as an anchorage device in the treatment of Class II since it does not depend on the patient’s compliance, making treatments more predictable.

All-On-4 na mandíbula e fixações zigomáticas na maxila em função imediata: relato de dois casos / Immediate function with All-On-4 in the mandible and zygomatic fixture in the maxilla: report of two cases

As alternativas de reabilitação implanto-suportada para os pacientes desdentados totais com reabsorções ósseas severas dos maxilares, sofreram enormes modifi cações com a evolução das técnicas de carga imediata e utilização de fixações zigomáticas que suprimem a utilização de técnicas de enxertia prévia, possibilitando a diminuição do trauma cirúrgico e a redução do tempo de tratamento. O objetivo deste artigo é apresentar dois casos clínicos de reabilitações totais com próteses fixas com função imediata, utilizando a técnica All-On-4 na mandíbula e fixações zigomáticas na maxila. Os resultados mostraram que maxilares desdentados atróficos podem ser reabilitados com técnicas menos invasivas e de maneira mais rápida em casos bem selecionados.