Class III camouflage orthodontic treatment in adult patient with anterior crossbite and abnormal functional shift: A case report

@#Skeletal Class III malocclusion is a complex malformation with a prevalence of 81.6% in Airlangga University Dental Hospital, distributed in patients aged 15-45 years old. Camouflage treatment of skeletal Class III malocclusion improves prognosis with a mild-to-moderate shift. This study aimed to discuss orthodontic camouflage as an option for adult patients with Class III malocclusion, emphasizing its indications, implications, and expected results. This report presents the case of a 17-year-old male patient with poor facial aesthetics associated with protruded chin, abnormal functional shift, and temporomandibular joint pain. The facial profile was concave with lower anterior multiple diastemas, mandibular lip protrusion, mandibular displacement, and anterior crossbite. This case was treated by camouflage therapy using straight wire appliance system combined with elastic class III. After 24 months of treatment during the pandemic, the mandibular displacement and the crossbite were corrected, the teeth were arched, the anterior crossbite fixed, and the profile became convex. Camouflage orthodontic treatment can be an effective management option to achieve functional occlusion, stability, and a satisfactory aesthetic impression in adult patients with mild to moderate skeletal Class III deformities, anterior cross bite, and functional shift.

Tratamento da classe III com disjunção maxilar e tração reversa da maxila: relato de caso clínico / Class III treatment weth maxillary disjunction and reverse maxillary traction: clinical case report

Objetivo: A má oclusão classe III de Angle se caracteriza por protrusão mandibular, retrusão maxilar ou pela combinação de ambas. Além de prejudicar a estética facial do paciente, essa má oclusão pode causar alterações funcionais e respiratórias. Uma das alternativas de tratamento para esses casos é o uso da máscara de Petit e do aparelho disjuntor de Hyrax. Este estudo tem como objetivo avaliar por meio da cefalometria ortodôntica se o tratamento com expansão maxilar em conjunto com a tração reversa da maxila diminuem os agravos estéticos e funcionais do paciente Classe III. Relato de caso: o relato de caso descrito no presente trabalho é sobre uma paciente que foi submetida a esse tratamento, sendo descrito por meio de análises cefalométricas, exames radiográficos, fotos intrabucais e achados clínicos. Considerações finais: A verificação dos resultados obtidos após o término do tratamento mostrou que a paciente teve uma boa adesão ao uso desses aparelhos e obteve resultados satisfatórios na sua função mastigatória, na sua oclusão e na sua estética facial e dentária.(AU)

Objective: Angle class III malocclusion is characterized by mandibular protrusion, maxillary retrusion or a combination of both. In addition to impairing the patient's facial aesthetics, this malocclusion can cause functional and respiratory changes. One of the treatment alternatives for these cases is the use of the Petit mask and the Hyrax breaker device. This study aims to evaluate, through orthodontic cephalometry, whether the treatment with maxillary expansion in conjunction with the reverse traction of the maxilla reduces the aesthetic and functional problems of Class III patients. Case report: the case report described in the present work is about a patient who underwent this treatment, being described through cephalometric analysis, radiographic examinations, intraoral photos and clinical findings. Final considerations: The verification of the results obtained after the end of the treatment showed that the patient had a good adherence to the use of these devices and obtained satisfactory results in her masticatory function, in her occlusion and in her facial and dental aesthetics.(AU)

Construction and functional analysis of EGFRvIII CAR-T cells co-expressing IL-15 and CCL19 / 生物工程学报

The aim of this study was to investigate the functional characteristics and in vitro specific killing effect of EGFRvIII CAR-T cells co-expressing interleukin-15 and chemokine CCL19, in order to optimize the multiple functions of CAR-T cells and improve the therapeutic effect of CAR-T cells targeting EGFRvIII on glioblastoma (GBM). The recombinant lentivirus plasmid was obtained by genetic engineering, transfected into 293T cells to obtain lentivirus and infected T cells to obtain the fourth generation CAR-T cells targeting EGFRvIII (EGFRvIII-IL-15-CCL19 CAR-T). The expression rate of CAR molecules, proliferation, chemotactic ability, in vitro specific killing ability and anti-apoptotic ability of the fourth and second generation CAR-T cells (EGFRvIII CAR-T) were detected by flow cytometry, cell counter, chemotaxis chamber and apoptosis kit. The results showed that compared with EGFRvIII CAR-T cells, EGFRvIII-IL-15-CCL19 CAR-T cells successfully secreted IL-15 and CCL19, and had stronger proliferation, chemotactic ability and anti-apoptosis ability in vitro (all P < 0.05), while there was no significant difference in killing ability in vitro. Therefore, CAR-T cells targeting EGFRvIII and secreting IL-15 and CCL19 are expected to improve the therapeutic effect of glioblastoma and provide an experimental basis for clinical trials.

Non-extraction camouflage treatment of skeletal class III malocclusion

@#Class III malocclusion can be defined as a skeletal facial deformity that is characterized by a forward mandibular position with respect to the cranial base and or the maxilla. We present a case of a 15-year-old man with skeletal Class III malocclusion who was treated with non-extraction orthodontic camouflage treatment using an orthodontic conventional technique. A fixed appliance, straight wire appliance (SWA) technique was used with a non-extraction treatment plan. Treatment was accompanied by intermaxillary Class III elastics. The total duration of active treatment was 23 months. There was a significant improvement in his occlusion, smile esthetics, and soft tissue profile pattern. Orthodontic camouflage can be considered an effective therapy for correcting milder cases of skeletal Class III malocclusion.

Nonsurgical orthodontic treatment in an adult with skeletal class III malocclusion using passive self-ligating system: A case report

@#Skeletal Class III malocclusion treatment is complex, especially when jaw deviations are serious. Camouflage treatment of skeletal Class III malocclusion improves prognosis with a slight-to-moderate functional shift. This report presents the case of a 23-year-old male with poor facial esthetics associated with chin protrusion and an uncomfortable bite. He had a concave profile, unfavorable incisor displays, protrusive lower lip, and strained lip closure. Camouflage therapy with a passive self-ligating (PSL) system through the anterior teeth of the maxilla protraction and arch expansion was used. After 14 months of treatment, the overjet outcome was positive. The teeth were arched, asymmetry was addressed, the convex profile and no deviation occurred when the jaw was closed. Factors in using the PSL system were low friction between the bracket and archwire, torque selection, and the significant dental arch expansion ability. The PSL system is an appropriate option in treating adults with skeletal Class III malocclusion to achieve a normal occlusion and a pleasant facial profile.

Evaluation of the maximum tongue and lip pressure in individuals with Class I, II, or III Angle malocclusions and different facial types / Avaliação da pressão máxima da língua e dos lábios em indivíduos com má oclusão Classe I, II e III de Angle e diferentes padrões faciais

ABSTRACT Purpose To compare the maximum anterior and posterior tongue pressure, tongue endurance, and lip pressure in Class I, II, and III malocclusions and different facial types. Methods A cross-sectional observational analytical study was carried out in 55 individuals (29 men and 26 women) aged between 18 and 55 years. The participants were divided into groups according to Angle malocclusion (Class I, II, and III) and facial type. The maximum anterior and posterior tongue pressure, tongue endurance, and maximum lip pressure were measured using the IOPI (Iowa Oral Performance Instrument). To determine the facial type, the cephalometric analysis was accomplished using Ricketts VERT analysis as a reference. Results There was no statistically significant difference when comparing the maximum pressure of the anterior and posterior regions of the tongue, the maximum pressure of the lips, or the endurance of the tongue in the different Angle malocclusion types. Maximum posterior tongue pressure was lower in vertical individuals than in mesofacial individuals. Conclusion Tongue and lips pressure, as well as tongue endurance in adults was not associated with the type of malocclusion. However, there is an association between facial type and the posterior pressure of the tongue.

RESUMO Objetivo comparar a pressão máxima anterior e posterior da língua, a resistência da língua e a pressão labial em indivíduos com más oclusões Classe I, II e III e diferentes tipos faciais. Método foi realizado um estudo analítico observacional transversal em 55 indivíduos (29 homens e 26 mulheres) com idades entre 18 e 55 anos. Os participantes foram divididos em grupos de acordo com a classificação de Angle para má oclusão (Classe I, II e III) e tipo facial. A pressão máxima anterior e posterior da língua, a resistência da língua e a pressão máxima dos lábios foram medidas usando o IOPI (Iowa Oral Performance Instrument). Para determinar o tipo facial, a análise cefalométrica foi realizada utilizando como referência a análise Ricketts VERT. Resultados não houve diferença estatisticamente significativa ao comparar a pressão máxima das regiões anterior e posterior da língua, a pressão máxima dos lábios ou a resistência da língua nos diferentes tipos de má oclusão. A pressão máxima posterior da língua foi menor em indivíduos com tipo facial vertical do que nos indivíduos mesofaciais. Conclusão a pressão de língua e lábios, assim como a resistência de língua em adultos não foi associada ao tipo de má oclusão. No entanto, existe uma associação entre o tipo facial e a pressão posterior da língua.

Assessment of influence of facemask treatment with skeletal anchorage on the temporomandibular joint using magnetic resonance imaging: a preliminary study

ABSTRACT Objective: The aim of the study was to investigate the influence of facemask treatment with skeletal anchorage on the temporomandibular joint (TMJ) using magnetic resonance imaging (MRI), in patients with Class III malocclusion, accompanied by maxillary retrusion. Methods: Fifteen patients with a mean age of 12.1±1.43 years were included in the study. All patients were treated using facemask with skeletal anchorage after eight weeks of Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol. Magnetic resonance imaging was performed before and immediately after facemask treatment for TMJ evaluation. Disc position, condylar translation, degenerative changes of the condyles, and joint effusion were evaluated. To assess whether the alterations associated with the treatment were statistically significant, McNemar and marginal homogeneity tests were used. Results: After facemask treatment, a statistically significant change was observed in the disc position (an anterior disc displacement with/without reduction in five TMJs) (p<0.05). The alteration in the condylar translation was not statistically significant (p>0.05). This treatment did not cause degenerative changes of the condyles or effusion in any of the TMJs. Conclusion: Facemask treatment with skeletal anchorage following the Alt-RAMEC protocol had a minimal influence on the TMJ, only by means of disc position, which was not negligible. Long-term results of such treatment are required for following up the changes observed in the TMJs.

RESUMO Objetivo: O objetivo desse estudo foi investigar a influência do tratamento com máscara facial com ancoragem esquelética na articulação temporomandibular (ATM), por meio de ressonância magnética (RM), em pacientes com má oclusão de Classe III acompanhada de retrusão maxilar. Métodos: Quinze pacientes com idade média de 12,1±1,43 anos foram incluídos no estudo. Todos os pacientes foram tratados com máscara facial com ancoragem esquelética após oito semanas de protocolo de Expansão Rápida da Maxila e Constrição Alternadas (Alt-RAMEC). Os exames de ressonância magnética foram realizados antes e imediatamente após o tratamento com máscara facial, para avaliação da ATM. Foram avaliados posição do disco, translação condilar, alterações degenerativas dos côndilos e derrame articular. Os testes de McNemar e de homogeneidade marginal foram utilizados para avaliar se as alterações associadas ao tratamento foram estatisticamente significativas. Resultados: Após o tratamento com máscara facial, uma mudança estatisticamente significativa foi observada na posição do disco (deslocamento anterior do disco com/sem redução em cinco ATMs) (p<0,05). A alteração na translação condilar não foi estatisticamente significativa (p>0,05). Esse tratamento não causou alterações degenerativas dos côndilos ou derrame em qualquer das ATMs. Conclusão: O tratamento com máscara facial com ancoragem esquelética ápós o protocolo Alt-RAMEC teve uma influência mínima na ATM, apenas quanto à posição do disco, que não foi desprezível. Resultados em longo prazo desse tratamento são necessários para acompanhar as mudanças observadas nas ATMs.

Class III treatment with mini-implants anchorage in young adult patients: short and long-term results

ABSTRACT Introduction: Class III malocclusion should be intercepted and treated at early age, to prevent the necessity of future complex and expensive procedures. The orthopedic facemask therapy has the goal to achieve skeletal changes, minimizing side effects on dentition. The use of skeletal anchorage, combined with Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol, may be effective in treating a greater number of growing Class III patients. Objective: To summarize the existing evidence-based literature on Class III malocclusion treatment in young adult patients, and to illustrate its application and effectiveness, by presenting an emblematic case report. Conclusion: The resolution of the present case, its long-term follow up, along with the studies conducted on a larger sample, demonstrate the effectiveness of the strategic combination of orthopedic and orthodontic treatments by using an hybrid rapid palatal expander and Alt-RAMEC protocol for treating Class III malocclusions in adult patients.

RESUMO Introdução: A má oclusão de Classe III deve ser interceptada e tratada em idade precoce, a fim de evitar uma futura necessidade de procedimentos complexos e invasivos. O tratamento com máscara facial ortopédica tem o objetivo de obter alterações esqueléticas, minimizando os efeitos colaterais na dentição. O uso de ancoragem óssea em mini-implantes, associada ao protocolo Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) pode ser eficaz no tratamento de um grande número de pacientes Classe III em crescimento. Objetivo: Realizar uma síntese da literatura baseada em evidência sobre o tratamento da má oclusão de Classe III em pacientes adultos jovens, e ilustrar sua aplicação e eficácia por meio do relato de um caso emblemático. Conclusão: A resolução e o acompanhamento em longo prazo do caso apresentado, juntamente com estudos conduzidos em uma amostra maior, demonstram a eficácia da combinação estratégica dos tratamentos ortopédico e ortodôntico usando um expansor palatal híbrido e o protocolo Alt-RAMEC para corrigir a má oclusão de Classe III em pacientes adultos.

Multi?Disciplinary Orthodontic Camouflage Treatment of a Severe Skeletal Class III Malocclusion with 1 Year Follow-Up – A Case Report

Rationale: Orthodontic camouflage serves its purpose in treating mild to moderate skeletal dysplasia and in conditions where the patient is reluctant to opt for orthognathic surgery or when it is contraindicated. Patient Concerns: A 22?year?old male was concerned about his irregular teeth. Diagnosis: Angle’s dentoalveolar class III malocclusion on class III skeletal on an average mandibular plane angle with anterior crossbite, deep bite, crowding in maxillary and mandibular anteriors, proclined maxillary anteriors and retroclined mandibular anteriors with reverse overjet and congenitally missing 12, 22, palatally impacted 13 and retained deciduous 63 and palatally placed 23. Treatment: Orthodontic camouflage with a multi?disciplinary approach. Outcome: Optimal functional and dentofacial aesthetics were achieved by 22 months. Take?Away Lesson: The limitations of camouflage must be kept in mind and explained to the patient. The biomechanics need to be customized and integrating different specialties helps maximize the treatment benefits.

Los bloques gemelos en el tratamiento de las maloclusiones clase III. Revisión / Twin blocks in the treatment of class III malocclusions. Review / Blocos gêmeos no tratamento das más oclusões de classe III. Revisão

RESUMEN El tratamiento de las maloclusiones clase III en pacientes en crecimiento suele realizarse con aparatos de ortopedia intraoral o extraoral. El objetivo fue analizar el uso de los bloques gemelos en el tratamiento de las maloclusiones de clase III. Se realizó una revisión sistemática siguiendo los lineamientos PRISMA versión 2009. Las búsquedas se realizaron en las bases de datos Pubmed, Embase, Scopus y Cochrane, así como en una base de datos de literatura gris, y se complementaron con búsquedas manuales. Se incluyeron cinco artículos de los cuales se registraron las siguientes variables: autor, año de publicación, país y resultados. De acuerdo a la bibliografía revisada, los bloques gemelos clase III constituyen una opción terapéutica que producen una mejoría de la estética facial al modificarse la relación esquelética máxilomandibular, la relación de oclusión dentaria anterior y la posición de los tejidos blandos.

ABSTRACT Treatment of class III malocclusions in growing patients is usually performed with intraoral or extraoral braces. The objective was to analyze the skeletal changes by treating class III malocclusions with twin blocks. A systematic review was carried out following the PRISMA 2009 version guidelines. Searches were carried out in the Pubmed, Embase, Scopus and Cochrane databases, as well as in a gray literature database, and were supplemented by hand searches. Five articles were included, of which the following variables were recorded: author, year of publication, country, and results. According to the reviewed bibliography, class III twin blocks constitute a therapeutic option that produces an improvement in facial aesthetics by modifying the maxillomandibular skeletal relationship, the anterior dental occlusion relationship, and the position of the soft tissues.

RESUMO O tratamento das más oclusões de classe III em pacientes em crescimento geralmente é realizado com aparelho intraoral ou extraoral. O objetivo foi analisar o uso de blocos gêmeos no tratamento das más oclusões de classe III. Uma revisão sistemática foi realizada seguindo as diretrizes do PRISMA versão 2009. As pesquisas foram realizadas nos bancos de dados Pubmed, Embase, Scopus e Cochrane, bem como em um banco de dados de literatura cinza, e foram complementadas por pesquisas manuais. Foram incluídos cinco artigos, dos quais foram registradas as seguintes variáveis: autor, ano de publicação, país e resultados. De acordo com a bibliografia revisada, os bloqueios gêmeos de classe III constituem uma opção terapêutica que produz uma melhora na estética facial ao modificar a relação esquelética maxilomandibular, a relação de oclusão dentária anterior e a posição dos tecidos moles.

Compensation in Class III Malocclusions: Analysis of Tooth Crown Inclination on Digital Dental Casts / Compensação da Má Oclusão de Classe III: Análise da Inclinação das Coroas dos Dentes em Modelos Digitais

The objective of this study was to evaluate the tooth crown inclination in maxillary and mandibular arches in Class III malocclusion individuals, to identify the presence and magnitude of compensation. The study was conducted on 46 plaster casts of individuals with Class III malocclusion, of both genders (25 males and 21 females), with mean age 21 years and 1 month, with indication for compensatory orthodontic treatment. The dental casts models were scanned and the tooth crown inclinations were measured and compared with standard values by the independent t test. All tests considered a significance level of 5% (p<0.05). According to the results there was extensive variation in tooth inclination in Class III malocclusions. Values distribution for incisors highlighted the significant concentration of maxillary incisors in the area of positive values, compared with a very expressive concentration of mandibular incisors in the area of negative values. Compared with normal standards, in Class III malocclusions, the maxillary posterior teeth exhibited smaller palatal inclination than normal, while the mandibular incisors and second molars presented greater lingual inclination. It was concluded that the analysis of inclinations of all crowns of both dental arches in Class III malocclusions, compared with normal standards, evidenced the presence of natural compensation for maxillary posterior teeth, with reduced palatal inclination, as well as increased lingual inclination in mandibular incisors. The parameters of compensation naturally present in Class III malocclusions described, especially in lower incisors, would help clinicians when compensatory treatment is considered. (AU)

O objetivo deste estudo foi avaliar a inclinação das coroas dentárias nas arcadas superior e inferior em indivíduos com má oclusão de Classe III, para identificar a presença e a magnitude da compensação. O estudo foi realizado em 46 modelos de gesso de indivíduos com má oclusão de Classe III, de ambos os sexos (25 homens e 21 mulheres), com média de idade de 21 anos e 1 mês, com indicação de tratamento ortodôntico compensatório. Os modelos de gesso foram digitalizados e as inclinações da coroa dos dentes foram medidas e comparadas com os valores de normalidade pelo teste t independente. Todos os testes estatísticos adotaram um nível de significância de 5% (p <0,05). De acordo com os resultados, houve grande variação na inclinação dentária nas más oclusões de Classe III. A distribuição dos valores para os incisivos destacou a concentração significativa de incisivos superiores na área de valores positivos, em comparação com uma concentração muito expressiva de incisivos inferiores na área de valores negativos. Comparados aos padrões de normalidade, nas más oclusões de Classe III, os dentes posteriores superiores exibiram inclinação palatina menor que o normal, enquanto os incisivos e segundos molares inferiores apresentaram inclinação lingual maior. Concluiu-se que a análise das inclinações de todas as coroas de ambas as arcadas dentárias nas más oclusões de Classe III, comparadas aos padrões de normalidade, evidenciou a presença de compensação natural para os dentes posteriores superiores, com diminuição da inclinação palatina, bem como aumento da inclinação lingual dos incisivos inferiores. Os parâmetros de compensação naturalmente presentes nas más oclusões de Classe III descritos, especialmente nos incisivos inferiores, podem auxiliar o clínico quando o tratamento compensatório é considerado. (AU)

Orthodontists' preferences in the use and timing of appliances for the correction of malocclusions in growing patients / Preferencias de los ortodoncistas en el uso y momento oportuno de uso de aparatos para la corrección de maloclusiones en pacientes en crecimiento

Objective: To evaluate orthodontists' preferences in the use and timing of appliances for the correction of Class II and Class III malocclusions in growing patients and the sociodemographic factors that influence these preferences. Material and Methods: Active members of the Colombian Orthodontics Society (SCO) were invited to complete a previously validated survey on the use of Class II and Class III correctors in growing patients. Results: 180 orthodontists responded (80 male, 100 female). The appliances used most frequently in the treatment of Class II malocclusion were Planas indirect tracks (32.78%) and Twin-blocks (30.56%). Facemasks (62.22%) and Progenie plates (25%) were the most prevalent appliances used in the treatment of Class III malocclusions. Regarding treatment timing, 52% of the orthodontists stated that Class II malocclusions must be treated during late mixed dentition or early permanent dentition, 42% stated that treatment for Class III malocclusions should occur during early mixed dentition. Appliance use and treatment timing were significantly associated with sex (p= 0.034), years of practice (p= 0.025), and area of work (private clinics or public institutions), (p= 0.039). Conclusion: Twin-blocks and Facemask appliances were the preferred appliances for Class II and Class III treatment, respectively, in growing patients. Most of the orthodontists believed that Class II malocclusions must be treated during late mixed dentition and that Class III malocclusions must be treated during early mixed dentition. Sociodemographic variables are related factors that influence orthodontists' preferences in the use of these appliances.

Objetivo: Evaluar las preferencias de los ortodoncistas en el uso y momento oportuno de uso de aparatología para la corrección de maloclusiones Clase II y Clase III en pacientes en crecimiento y los factores sociodemográficos que influyen en estas preferencias. Material y Métodos: Se invitó a miembros activos de la Sociedad Colombiana de Ortodoncia (SCO) a completar una encuesta previamente validada, sobre el uso de correctores para Clase II y Clase III en pacientes en crecimiento. Resultados: Respondieron un total de 180 ortodoncistas (80 hombres, 100 mujeres). La aparatología más utilizada en el tratamiento de las maloclusiones de Clase II fueron pistas indirectas de Planas (32,78%) y bloques gemelos (30,56%). La máscara facial (62,22%) y las placas progenie (25%) fueron los aparatos más utilizados en el tratamiento de las maloclusiones de Clase III. En cuanto al momento oportuno del tratamiento, el 52% de los ortodoncistas afirmó que las maloclusiones de Clase II deben tratarse durante la dentición mixta tardía o la dentición permanente temprana, el 42% afirmó que el tratamiento para las maloclusiones de Clase III debe ocurrir durante la dentición mixta temprana. El uso de aparatos y el momento oportuno del tratamiento se asociaron significativamente con el sexo (p= 0,034), los años de práctica (p= 0,025) y el área de trabajo (clínicas privadas o instituciones públicas) (p= 0,039). Conclusión: Los aparatos bloques gemelos y la máscara facial fueron los preferidos para el tratamiento de Clase II y Clase III, respectivamente, en pacientes en crecimiento. La mayoría de los ortodoncistas consideran que las maloclusiones de Clase II deben tratarse durante la dentición mixta tardía y que las maloclusiones de Clase III deben tratarse durante la dentición mixta temprana. Las variables sociodemográficas son factores relacionados que influyen en las preferencias de los ortodoncistas en el uso de estos aparatos.

Interdisciplinariedad en el diagnóstico del síndrome de clase III esquelético de Moyers / Interdisciplinarity in the diagnosis of Moyers skeletal class III syndrome

RESUMEN Fundamento: Dentro de las anomalías de la oclusión que provocan afectación estética y funcional en los pacientes, se destaca el síndrome de clase III esqueletal de Moyers, cuyo diagnóstico debe ser preciso y precoz. Objetivo: Cuantificar la concordancia entre los criterios diagnósticos ortodóncicos y médicos en los portadores del síndrome de clase III esquelético de Moyers. Metodología: Se realizó un estudio observacional, descriptivo y transversal en la Clínica Estomatológica Provincial Docente "Mártires del Moncada" de Santiago de Cuba desde enero de 2018 hasta enero de 2020. Se estudiaron, por Ortodoncia y diferentes especialidades médicas seleccionadas, 15 pacientes de 8 a 18 años de edad diagnosticados clínica y cefalométricamente con clase III esqueletal de Moyers. Resultados: El nivel de acuerdo entre ortodoncia y las diferentes especialidades médicas fue leve con Oftalmología (Kappa=0.10), casi perfecta con Ortopedia (Kappa=1.00), pobre por Gastroenterología y por Otorrinolaringología (Kappa de 0.09 y 0.10 respectivamente), resultados estadísticamente significativos solo con Ortopedia. Conclusiones: Es evidente la marcada concordancia entre los diagnósticos ortodóncicos y ortopédicos en el síndrome de clase III esquelético, a diferencia del resto de las especialidades médicas; probablemente asociado a la no estandarización de las evaluaciones clínicas.

ABSTRACT Background: Among the occlusion anomalies that cause esthetic and functional affectation in patients, Moyers skeletal class III syndrome stands out, its diagnosis should be accurate and early. Objective: To quantify the concordance between orthodontic and medical diagnostic criteria in patients with Moyers skeletal class III syndrome. Methodology: An observational, descriptive and cross-sectional study was conducted at the "Mártires del Moncada" Provincial Teaching Dental Care Clinic of Santiago de Cuba from January 2018 to January 2020. 15 patients aged 8 to 18 years clinically and cephalometrically diagnosed with Moyers skeletal class III were studied by Orthodontics and different selected medical specialties. Results: The level of agreement between Orthodontics and the different medical specialties was slight for Ophthalmology (Kappa=0.10), almost perfect for Orthopedics (Kappa=1.00), poor for Gastroenterology and Otolaryngology (Kappa of 0.09 and 0.10 respectively), statistically significant results only for Orthopedics. Conclusions: The manifest concordance between orthodontic and orthopedic diagnoses in skeletal class III syndrome is evident, unlike the rest of the medical specialties; probably associated with non-standard clinical evaluations.

Análisis de los fundamentos biológicos del Sistema Ertty Gap III®

RESUMEN: Las maloclusiones clase III durante muchos años han sido un reto en ortodoncia, siendo reconocidas como un desafío diagnóstico y terapéutico para el clínico. En la mayoría de los casos, si no se realiza un tratamiento temprano, la cirugía ortognática se transforma en la única opción para establecer una oclusión correcta y mejorar las caracterÍsticas faciales. El objetivo principal de la intervención temprana, es crear un entorno más favorable para el crecimiento. A lo largo de la historia se han utilizado distintos aparatos ortopédicos para el tratamiento temprano de esta maloclusión, sin embargo se ha observado que muchas veces sus resultados son insuficientes o ineficaces. El Sistema Ertty Gap III® , viene a revolucionar el enfoque con el cual se trataban las maloclusiones Clase III, orientando los efectos terapéuticos a la premaxila, la cual se pensaba inactiva como sitio de crecimiento. La evidencia actual respecto a este sistema es escasa, sin embargo, el uso de ortopedia de fácil manejo a un bajo costo económico, ofrece una alternativa terapéutica en etapas tempranas que permitiría crear un entorno más favorable para el crecimiento, la oclusión y la estética facial.

ABSTRACT: Class III malocclusions have been a challenge in orthodontics for many years, recognized as a diagnostic and therapeutic challenge for the clinician. In most cases, if early treatment is not performed, orthognathic surgery becomes the only option to achieve a correct occlusion and improve facial characteristics. The main goal of early intervention is to create a more favorable environment for growth. Throughout history, different orthopedic devices have been used for the early treatment of this malocclusion. However, it has been observed that their results are often insufficient or ineffective. The Ertty Gap III System comes to revolutionize the approach to the treatment of Class III malocclusions, directing the therapeutic effects to the premaxilla, which was thought to be an inactive growth site. The current evidence regarding this system is scarce; however, easy-to-use orthopedics at a low cost offers a therapeutic alternative in early stages that would allow a more favorable environment for craniofacial growth, occlusion and facial aesthetics.

Effects of different force directions of intra-oral skeletally anchored maxillary protraction on craniomaxillofacial complex, in Class III malocclusion: a 3D finite element analysis

ABSTRACT Introduction: The intra-oral skeletally anchored maxillary protraction (I-SAMP) has been found to be an effective treatment for skeletal Class III malocclusion. Objective: This in-silico study explored the influence of different force directions of intra-oral skeletally anchored Class III elastics on the changes in craniomaxillofacial complex, using finite element analysis. Methods: A 3-dimensional (3D) finite element model of the craniomaxillofacial bones including circummaxillary sutures was constructed with high biological resemblance. A 3D assembly of four miniplates was designed and fixed on the maxilla and mandible of the finite element model. The model was applied with 250g/force at the miniplates at three angulations (10°, 20°, and 30°) from the occlusal plane, to measure stress and displacement by using the ANSYS software. Results: The zygomaticotemporal, zygomaticomaxillary, and sphenozygomatic sutures played significant roles in the forward displacement and counterclockwise rotation of maxilla and zygoma, irrespective of the angulation of load application. The displacements and rotations of the zygomatico-maxillary complex decreased gradually with an increase in the angle of load application between miniplates from 10° to 30°. The mandible showed negligible displacement, with clockwise rotation. Conclusions: The treatment effects of I-SAMP were corroborated, with insight of displacement patterns and sutures involved, which were lacking in the previously conducted 2D and 3D imaging studies. The prescribed angulation of skeletally anchored Class III elastics should be as low as possible, since the displacement of zygomatico-maxillary complex increases with the decrease in angulation of the elastics.

RESUMO Introdução: A protração maxilar com ancoragem esquelética intrabucal (I-SAMP) tem sido considerada um tratamento efetivo para a má oclusão esquelética de Classe III. Objetivo: O presente estudo in silico avaliou, usando análise de elementos finitos, a influência de diferentes direções da força dos elásticos Classe III com ancoragem esquelética intrabucal nas mudanças no complexo craniomaxilofacial. Métodos: Um modelo de elementos finitos tridimensional (3D) dos ossos craniomaxilofaciais, incluindo as suturas circum-maxilares, foi construído, com alta semelhança biológica. Uma montagem 3D de quatro miniplacas foi projetada e fixada na maxila e na mandíbula do modelo de elementos finitos. O modelo foi aplicado com o uso de 250g/força nas miniplacas em três angulações (10°, 20° e 30°) em relação ao plano oclusal, para medir as tensões e os deslocamentos, usando o programa ANSYS. Resultados: As suturas zigomaticotemporal, zigomaticomaxilar e esfenozigomática desempenharam um papel significativo no deslocamento para anterior e na rotação anti-horária da maxila e do zigoma, independentemente da angulação na aplicação da força. Os deslocamentos e as rotações do complexo zigomático-maxilar diminuíram gradualmente com o aumento de 10° para 30° no ângulo de aplicação da força entre as miniplacas. A mandíbula apresentou deslocamento irrelevante, com rotação no sentido horário. Conclusões: Os efeitos do tratamento com I-SAMP foram corroborados, com um vislumbre dos padrões de deslocamento e das suturas envolvidas, que não existiam nos estudos com imagens 2D e 3D realizados anteriormente. A angulação dos elásticos Classe III ancorados esqueleticamente deve ser a menor possível, visto que o deslocamento do complexo zigomático-maxilar aumenta com a redução no ângulo dos elásticos.

Diagnóstico e tratamento precoce da má oclusão de Classe III com Aparelho Disjuntor Hyrax e Máscara Facial de Petit com avaliação do tempo de uso com micro-sensor: relato de caso clínico / Early diagnosis and treatment of Class III occlusion with Hyrax Isolating Appliance and Petit Face Mask with evaluation of the time of use with micro-sensor: a clinical case report

O sucesso do tratamento precoce da classe III depende de um bom diagnóstico e da cooperação do paciente na utilização do aparelho extrabucal. Neste trabalho, por meio de um chip (Theramon) instalado na Máscara Facial de Petit da paciente, foi possível monitorar a quantidade de horas que a paciente utilizou o aparelho por dia, durante um período de quatro meses. Paciente do sexo feminino, 7 anos e 11 meses de idade portadora da má oclusão de classe III, utilizou o aparelho de disjunção da maxila (Hyrax) modificado, seguido da Máscara Facial de Petit com chip (Theramon) instalado. A média de uso foi maior do que 11 horas de uso diário. O uso deste dispositivo auxilia no monitoramento do tempo de uso do aparelho, cujo sucesso do tratamento depende da utilização deste pelo paciente(AU)

The success of early treatment of class III depends on a good diagnosis and the cooperation of the patient in the use of the extra oral appliance. In this study, the patient was able to monitor the number of hours the patient used the device per day during a period of four months using a Theramon chip installed in the Patient's Facial Mask. A 7-year, 11-month-old male with Class III malocclusion used the modified maxillary disjunction (Hyrax), followed by the Petit Facial Mask with a Theramon chip installed. The average use was greater than 11 hours of daily use. The use of this device assists in the monitoring of the time of use of the device, whose success of the treatment depends on the use of this by the patient(AU)

Osteotomía Le Fort III modificada en un paciente no sindrómico / Modified Le Fort III osteotomy in a non-syndromic patient

Las discrepancias dento-esqueletales severas presentan un reto para el cirujano maxilofacial, existe una versatilidad de osteotomías para las diferentes anomalías del crecimiento y desarrollo, sin embargo, son pocas las que permiten mejorar la proyección malar. La osteotomía Le Fort III modificada fue utilizada en un principio en pacientes con algún síndrome craneofacial, pero actualmente es una alternativa útil para discrepancias severas en pacientes no sindrómicos, ya que permite un avance cigomático-maxilar, favorece la proyección malar y disminuye la exposición escleral con un número limitado de complicaciones. Se presenta el caso de un paciente masculino de 33 años con antecedente de fractura orbitocigomática y piso orbitario izquierda con una discrepancia dento-esqueletal severa, la que fue tratada mediante osteotomía Le Fort III modificada, osteotomías sagitales mandibulares para un avance máxilo-malar y retroceso mandibular respectivamente y una genioplastia de avance; logrando un resultado funcional y estético adecuado.

The dento-skeletal severe discrepancies present a challenge for the maxillofacial surgeon, there is a versatility of osteotomies for the different growth and development anomalies, however, a few of them make possible to improve malar projection. The modified Le Fort III osteotomy was originally used in patients with some craniofacial syndrome, but now it is a useful alternative for severe discrepancies in non-syndromic patients, since it allows a zygomatic-maxillary advance, favors malar projection and reduces scleral exposure with a limited number of complications. The case of a 33-year-old male patient with a history of orbitozygomatic fracture and left orbital floor with a severe dento-skeletal discrepancy is presented, who was treated by modified Le Fort III osteotomy, mandibular sagittal osteotomies for maxillo-malar advancement and retrogression mandibular respectively and geniplasty for advance; achieving a suitable functional and aesthetic result.

Revisión de los principales manejos ortodónticos interceptivos y correctivos no quirúrgicos de la maloclusión clase III / Review of the main non-surgical interceptive and corrective orthodontic management of Class III malocclusion

La maloclusión clase III se considera un reto en la práctica de todo ortodoncista. Una de las principales dudas al respecto reside en ¿cuándo es el mejor momento para intervenir? Exis- ten dos enfoques en el manejo ortodóntico del paciente: 1) la ortodoncia interceptiva; y 2) la ortodoncia correctiva. La or- todoncia interceptiva busca la prevención del establecimiento de la malolcusión. En este grupo, se encuentra el uso de más- cara facial con disyunción maxilar y el de aparatología fija (2x4 o 2x6). Por otro lado, la intervención correctiva hace re- ferencia al camuflaje de las características que trae consigo la maloclusión clase III ya establecida; dentro de este enfoque se encuentran las extracciones de piezas, el uso de minitornillos extraalveolares y la filosofía MEAW. Se puede concluir que el adecuado manejo de la maloclusión clase III radica en el oportuno y correcto diagnóstico, que debe realizarse a través de la minuciosa inspección de las características y hallazgos intra y extraorales de los pacientes (AU)

Class III malocclusion is considered a challenge in the practice of every orthodontist. One of the main questions is: when is the best time to intervene? There are 2 approaches to the orthodontic management of the patient: 1) interceptive orthodontics, and 2) corrective orthodontics. Interceptive or- thodontics seeks to prevent the establishment of malocclusion by means of the use of a facial mask with maxillary disjunc- tion, or the use of fixed appliances (2x4 or 2x6). Corrective intervention refers to camouflaging the characteristics of a Class III malocclusion that is already established. This ap- proach uses tooth extraction, extra-alveolar mini screws or the MEAW philosophy. To conclude, proper management of Class III malocclu- sion is based on timely, correct diagnosis, which must be made through careful inspection of the characteristics and intraoral and extraoral findings in patients (AU)

Clase III esqueletal ­ cuando todas las estrategias son insuficientes: reporte de un caso clínico / Skeletal class III - when all strategies are insufficient: report of a clinical case

Desde la antigüedad la belleza y la armonía facial han sido objetivos que tanto pintores como escultores, médicos y las personas tratan de lograr. Los rostros han sido estereotipados y es así como las caras proporcionadas tanto en alto como en ancho con perfiles que son rectos o levemente convexos son los que se asocian a bondad, generosidad, personas con luz interior, princesas y son las "buenas de las películas". Pero ¿qué sucede con aquellos rostros cóncavos, con tercios inferiores ya largos o cortos?… a ellos les ha tocado la peor parte, son los malos, los oscuros, los "villanos de las películas". Objetivos La finalidad de este trabajo es acercar a los colegas ortodoncistas una opción de tratamiento en clase III esqueletal, cuando el camuflaje ortodóncico no alcanza para resolver el crecimiento alterado entre el maxilar superior y el maxilar inferior (AU)

Beauty and facial harmony have been, since the beginning of humanity, a target for artists, painters, sculptores, and even people and doctors to accomplish. There is a stereotype of beauty: faces with proportional dimensions both in height and length, with straight profiles or somehow convex are associated with kindness, generosity and inner beauty. We can see this in movies where the heroes, the princesses, the "good guys" are portrayed with these types of faces. And what happens with people with concave faces, long or short inferior thirds? They are doomed to be the evil, the dark and "the villains" (AU)

Corrección de una clase III esqueletal con anclaje óseo en paciente en crecimiento: Reporte de caso / Skeletal class III correction in growing patient with bone anchorage: CaseReport

Antecedentes: La clase III esqueletal, es una deformidad dentofacial donde el tercio inferior de la cara es más prominente, el tratamiento se decide según la etiología y la edad del paciente; si se encuentra en crecimiento la malformación puede ser tratada con un protocolo interceptivo y si es posible evitar la cirugía ortognática a futuro. Objetivo: Mejorar la clase esqueletal, descruzar la mordida u obtener mordida borde a borde, mejorar la posición del labio superior y evaluar el comparativo inicial-final de SNA y ANB. Reporte de caso:Paciente masculino de 13 años, sin antecedentes personales patológicos o familiares reportados; presenta clase III esqueletal responsiva bimaxilar, crecimiento vertical, clase molar I y canina III; fue tratado con el protocolo de mini placas BAMP (bone anchored maxillary protraction) por sus siglas en inglés, elásticos intermaxilares y un paladar con pistas planas. Resultados:La fase ortopédica duro cinco meses y se logró mordida borde a borde y clase I esqueletal. Discusión: Se obtuvieron resultados con el uso de mini implantes sin anclaje extraoral en menos tiempo a comparación de otros métodos que tienen que ser usados por 9-12 meses.Conclusión:El protocolo BAMP puede ser usado en pacientes en crecimiento sin máscara facial para corregir la clase III esqueletal.

Background: Skeletal class III is a dentofacial deformity where the lower third ofthe face is more prominent. The treatment is decided according to the etiology and age of the patient; If the patient is in growing, the malformation can be treated with an interceptive protocol and if possible, avoid a orthognathic surgery in the future. Objective: Improve the skeletal class, uncross the bite or obtain an edge-to-edge bite, improve the position of the upper lip and compare the initial-final relationship of ANS and ANB.Case report:13-year-old male patient, with no reported pathological or family history; presents skeletal class III, vertical growth, molar class I and canine III; he was treated with the protocol of mini BAMP (bone anchored maxillary protraction) plates, intermaxillary elastics and a palate with flat tracks. Results:The orthopedic phase lasted five months and an edge-to-edge bite and skeletal class I were achieved.Discussion:Results were obtained with the use of mini plates without extraoralanchorage in less time compared to other methods that have to be used for 9-12 months. Conclusion: The BAMP protocol can be used in growing patients without a face mask to correct skeletal class III.