Complicaciones Asociadas a la Remoción Estética del Cuerpo Adiposo de la Boca (de Bichat) - Revisión Narrativa / Complications Associated with Aesthetic Removal of the Buccal Adipose Body (Bichat's fat-pad) - Narrative Review

El cuerpo adiposo de la boca (CAB) es un componente adiposo multilobulado bien delimitado, localizado de manera bilateral en la región facial íntimamente relacionado a estructuras nerviosas y vasculares. La remoción de CAB es un procedimiento ampliamente estudiado en el campo de la cirugía maxilofacial, utilizado principalmente para cubrir defectos. Su influencia en la estética facial ha iniciado una popularización de la remoción de la extensión bucal de CAB para obtener un rostro más estilizado, intervención difundida como poco invasiva y sin complicaciones. El objetivo de este estudio fue recopilar y evaluar estudios que reporten y evalúen complicaciones asociadas a la remoción por razones estéticas de CAB. Se revisó la evidencia en las bases de datos Medline vía PubMed, Epistemonikos, Scopus y Google Scholar, utilizando términos predefinidos, seleccionando estudios primarios de reportes de casos. Se incluyeron 7 artículos con un total de 10 pacientes; de estos, ocho pacientes se realizaron este procedimiento en Brasil, uno en Estados Unidos y uno en Chile. La distribución de la población fue de 3:7 entre hombres y mujeres con edad promedio de 35 años y un rango entre los 23 a los 49 años. En relación a las complicaciones reportadas, 100 % de los pacientes presentaron asimetría facial, un 80 % presentó edema facial, 30 % manifestaron sialocele, Trismus 20 %, 40 % presentó hematoma, 20 % compromiso del estado general, 20 % presentaron disfagia, en los casos de hipoestesia, parestesia, absceso, seroma, parálisis facial, odinofagia, fiebre se expresaron en 10 % de la población estudiada. En todos los estudios se describió una reintervención quirúrgica posterior a la remoción estética del cuerpo adiposo de bichat. La escasa literatura y la baja calidad de esta, no permite estimar el porcentaje real de posibles complicaciones, tampoco es posible determinar sus resultados a largo plazo ya que no existe en la evidencia un seguimiento apropiado para estos pacientes.

The buccal adipose body (BAB) is a well- defined multilobulated adipose component, located bilaterally in the facial region, closely related to nervous and vascular structures. BAB removal is a widely studied procedure in the field of maxillofacial surgery, used mainly to cover defects. Its influence on facial aesthetics has started to popularize the removal of the BAB buccal extension to obtain a more stylized face, an intervention widely known as minimally invasive and without complications. The objective of this study was to collect and evaluate studies that report and evaluate complications associated with the removal of BAB for cosmetic reasons. The evidence was reviewed in the Medline databases via PubMed, Epistemonikos, Scopus, and Google Scholar, using predefined terms, selecting primary studies from case reports. 7 articles with a total of 10 patients were included; Of these, eight patients underwent this procedure in Brazil, one in the United States, and one in Chile. The distribution of the population was 3:7 between men and women with an average age of 35 years and a range between 23 to 49 years. In relation to the reported complications, 100 % of the patients presented facial asymmetry, 80 % presented facial edema, 30 % manifested sialocele, trismus 20 %, 40 % presented hematoma, 20 % compromised general state, 20 % presented dysphagia, in the cases of hypoesthesia, paresthesia, abscess, seroma, facial paralysis, odynophagia, fever were expressed in 10 % of the studied population. All the studies described a surgical reintervention after cosmetic removal of the bichat adipose body. The scarce literature and its low quality do not allow estimating the real percentage of possible complications, nor is it possible to determine their long-term results since there is no evidence of appropriate follow-up for these patients.

Estética y patrones craneofaciales en la Ortodoncia / Aesthetics and craniofacial patterns in Orthodontics

RESUMEN La belleza se puede definir como una combinación de cualidades que dan placer a los sentidos o a la mente. En Ortodoncia, la mayoría de los pacientes acuden a consulta para mejorar su estética. Las características faciales y esqueléticas determinan el desarrollo del patrón facial, este puede ser descrito y cuantificado y es resultado del crecimiento. Dicho aspecto, ofrece, además, las bases para el diagnóstico correcto de la anomalía dentomaxilofacial y es un requisito para lograr una estética y una función adecuadas. Se realizó un estudio de los diferentes conceptos de estética y los análisis craneofaciales tomados en cuenta a lo largo de la historia de la Ortodoncia para definir tratamientos y diagnósticos en los pacientes. Si bien existen numerosos estudios que avalan la importancia de estos datos para llegar a la armonía facial, es evidente la ausencia de un acercamiento a la realidad cubana y su diversidad de razas.

ABSTRACT Beauty can be defined as a combination of qualities that give pleasure to the senses or to the mind. In Orthodontics, most patients come for consultation to improve their aesthetics. Facial and skeletal characteristics determine facial pattern development, which can be described and quantified and is the result of growth. It also provides the basis for the correct diagnosis of dentomaxillofacial anomalies and is a prerequisite for adequate function and aesthetics. A study of the different aesthetics concepts and the craniofacial analysis, throughout the history of Orthodontics, was made to define treatments and diagnoses in patients. Although there are numerous studies that endorse the importance of these data to achieve facial harmony, it is evident that there is no an approach to the Cuban reality and its racial diversity.

Evaluation of dental school student's satisfaction regarding their own smile esthetics and facial profile

Introduction: Facial aesthetics is especially important in a person's life. However,what is considered aesthetic by the orthodontist does not always correspond withthe patient's opinion, since aesthetics is very subjective. Thus, the aim of this studyis to evaluate the perception of dentalgraduate students in relation to their ownsmile and facial profile, analyzing if there would be any difference between thisself-evaluation associated with the year students are attending in dental schooland the technical knowledge progressively acquired. Materials and methods: Atransverse observational study was performed, in which a questionnaire wasapplied to all dentistry students at the State University of Rio de Janeiro. Thequestionnaire inquired about: student's current semester, age, gender, nationality,and previous history of orthodontic treatment. It also contained a Likert scale ofsatisfaction about their smile, the aesthetic component of the Index of OrthodonticTreatment Need (IOTN) for students to compare with their smile, and a scale forfacial profile comparison. The chi-squared test was applied using the SPSS 13.0software and all analyzes were performed with 95% confidence (p < 0.05). Results:A total of 253 questionnaires were distributed and 166 were filled out. Amongthose, 103 people reported having had orthodontic treatment before. The level ofsatisfaction with their own smile was high, reaching 78% in the first year of thecourse, 63% in the second, 87% in the third, and 72% in the fourth year. There wasa preference for a slightly convex profile for both genders. It is observed that 62%of the sample reported having been submitted to orthodontic treatment beforeand the percentage of white students who had received previous orthodontictreatment was substantially higher than other ethnicities. The qui-square testfound a significant statistical difference in ethnicity among students that hadreceived previous orthodontic treatment (p=0.008). Conclusion: There was nodifference in the aesthetic perception of the smile and profile in relation to theyear attended by dental school students, with the level of satisfaction with theirown smile being high.

Introdução: A estética facial apresenta grande importância na vida dos indivíduos. Entretanto, nem sempre o considerado estético pelo ortodontista corresponde com a opinião do paciente, visto que a estética é subjetiva. Assim,objetivou-se avaliar a percepção de graduandos da faculdade de Odontologia, em relação ao próprio sorriso e perfil facial, analisando se haveria diferença nesta percepção em relação ao período que cursariam e à medida que os conhecimentos são adquiridos. Materiais e Métodos: Desenvolveu-se este estudo observacional transversal, no qual distribuiu-se um questionário para todos os alunos do curso de Odontologia da Universidade do Estado do Rio de Janeiro. O questionário continha perguntas sobre o período cursado, idade, sexo, naturalidade, história prévia de tratamento ortodôntico, satisfação com o sorriso, índice de Necessidade de Tratamento Ortodôntico (IOTN) para ser comparado com o sorriso, além de escala para comparação do perfil facial. O teste do qui-quadrado foi aplicado no software SPSS 13.0 e todas as análises foram realizadas com 95% de confiança (p<0,05). Resultados: Foram preenchidos 166 dos 253 questionários distribuídos. Destes, 103 alunos relataram tratamento ortodôntico prévio. O grau de satisfação com o próprio sorriso foi alto, sendo de 78% no primeiro ano de faculdade, 63% no segundo, 87% no terceiro e 72% no quarto ano. Houve preferência pelo perfil levemente convexo para ambos os gêneros. Foi observado que 62% da amostra já havia feito tratamento ortodôntico, sendo a maioria da etnia branca. O teste qui-quadrado encontrou diferença estatisticamente significativa na etnia dos estudantes que receberam tratamento ortodôntico prévio (p=0,008). Conclusão: Não houve diferença na percepção estética do próprio sorriso e perfil em relação ao período cursado, sendo o grau de satisfação com o próprio sorriso bastante alto.

About chin (genioplasty) surgery / Sobre cirugía del mentón (genioplastía)

Facial harmony is the consequence of a proper balance between all facial structures. The identification and classification of morphologic characteristics that detract from facial harmony is most effectively accomplished by clinical examination. The maintenance of the ratios between the facial thirds, correct spatial bone position and soft tissues accommodation are all factors that directly contribute in a balanced facial profile. The chin, likewise, contributes significantly in facial balance, mainly in the profile view. Expressive changes on chin position are associated with the perception of strong or delicate characters. Thus, over the years, a series of studies has been constructed focusing on mandibular osteotomies techniques that enable changes in chin position: advances, setback, extrusion, intrusion, widening, narrowing and asymmetry. This study aims to address historical and technical aspects of genioplasty; associating patient's condition with the surgical techniques that can be applied for correction of chin deformities.

La armonía facial es la consecuencia del balance entre las estructuras facial. La identificación y clasificación de las características morfológicas que están acompañando la armonía facial son mas efectivas al realizar un estudio de análisis facial. La obtención de promedios entre los tercios, corrección especial de la posición del hueso y la acomodación de los tejidos blandos son factores directamente involucrados en el balance del perfil. El mentón, contribuye significativamente en este balance. Cambios expresivos en la posición del mentón son asociados con la percepción de características fuertes o delicadas. Durante los años, una serie de estudios han sido desarrollados enfocándose en las osteotomías mandibulares y técnicas capaces de alcanzar los cambios en la posición del mentón: avances, retrocesos, extrusiones, ensanchamientos, estrechamientos y asimetrías. Este estudio pretende orientar las condiciones históricas y técnicas respecto de la genioplastia; la asociación de las características del paciente con la técnica quirúrgica pueden ser aplicadas para la corrección de las deformidades.

Planificación en ortodoncia a partir del incisivo superior: una propuesta de VTO / Planning in orthodontics from the upper incisor: a VTO proposal

Para adecuarnos a los objetivos estéticos de la ortodoncia actual, y con el fin de lograr una planificación más eficiente, hemos propuesto una modificación al objetivo visual de tratamiento (VTO) tradicional de Ricketts. En este método, sugerimos comenzar la planificación ortodóncica evaluando la estética de los tejidos blandos y la sonrisa del paciente, de forma individualizada para cada caso según su arquetipo facial, tomando como punto de partida la posición deseada del incisivo superior, dando importancia a las posibilidades de modificación del plano oclusal, de la altura del tercio inferior de la cara y de la proyección del mentón a partir de la autorrotación mandibular. Durante este proceso se utilizan, además de la telerradiografía de perfil, las fotos del paciente de frente y de perfil para planear cambios de forma visual, a través del efecto morphing, todo esto facilitado por el uso de un software de diseño(AU)

For adapting us to the aesthetics objectives of today's orthodontics, and in order to achieve a more efficient planning, we have proposed a modification to the traditional Ricketts' visual treatment objective - VTO. In this method, we suggest starting orthodontic planning by evaluating the aesthetics of soft tissues and the smile of the pacient, in a customized way for each case according to facial archetype, taking as a starting point the desired position of the upper incisor, giving importance to the possibilities for occlusal plane changing, to the height of the lower third of the face and to the projection of the chin from the mandibular autorotation. During this process, in addition to profile teleradiography, full-face and profile pictures of the patient are used to plan visual changes through morphing, all of this was facilitated by the use of design software(AU)

Tratamiento de la clase III esquelética máxilo-mandibular con twin block / Treatment of skeletal Class III maxillo-mandibular relationship with the twin block appliance

RESUMEN Introducción: la clase III esquelética máxilo-mandibular se caracteriza por la relación no fisiológica de los arcos dentarios, perfil cóncavo, discrepancia sagital máxilo-mandibular y alteraciones funcionales que perturban el funcionamiento del sistema estomatognático. En la literatura nacional e internacional no existe evidencia de la eficacia del tratamiento con twin block de la clase III esquelética máxilo-mandibular. Objetivo: evaluar el tratamiento de la clase III esquelética máxilo-mandibular con el uso de twin block. Material y Métodos: se realizó un estudio de intervención de tipo cuasi-experimental, en 43 pacientes con clase III esquelética máxilo-mandibular, en la Clínica Universitaria de Especialidades Estomatológicas "Manuel Cedeño", en el período de enero de 2018 a junio de 2019. Se estudiaron las variables: relación de oclusión, clasificación esquelética máxilo-mandibular, disfunción de la articulación temporomandibular y estética facial. A todos los pacientes se les aplicó el twin block como parte del tratamiento ortopédico-funcional. Resultados: inicialmente el 86,04% de los pacientes tenían una mesioclusión, la que se modificó a neutroclusión en el 81,39%. La clasificación esquelética se corrigió en el 88,37% de los casos. La disfunción de la articulación temporomandibular mejoró, a leve, en el 51,16% de los pacientes. La estética facial resultó no afectada en el 83,72%. Conclusiones: Con el uso de twin block se corrige la relación de oclusión dentaria y la clase III esquelética máxilo-mandibular, además de ser una opción terapéutica que mejora la disfunción de la articulación temporomandibular y la estética facial en pacientes con esta anomalía dentomaxilofacial.

ABSTRACT Introduction: Skeletal Class III maxillo-mandibular relationship is characterized by the non-physiological relationship between the dental arches, concave profile, maxillo-mandibular sagittal discrepancy and functional alterations that disturb the functioning of the stomatognathic system. In the national and international literature, there is no evidence of the effectiveness of treatment of Skeletal Class III maxillo-mandibular relationship with the use of twin block appliance. Objective: To evaluate the treatment of skeletal Class III maxillo-mandibular relationship with the use of twin block appliance. Material and Methods: A quasi-experimental intervention study was conducted in 43 patients with skeletal Class III maxillo-mandibular relationship at Manuel Cedeño Dental Specialties University Clinic during the period between January 2018 and June 2019. The study variables were: occlusion ratio, maxillo-mandibular skeletal classification, temporomandibular joint dysfunction and facial esthetics. The twin block appliance was applied to all patients as part of the orthopedic functional treatment. Results: Initially, 86,04 % of the patients had a mesioclusion, which was modified to neutroclusion in 81,39 %. Skeletal classification was corrected in 88,37 % of cases. Temporomandibular joint dysfunction improved to mild in 51,16 % of patients. Facial esthetics was not affected in 83,72 %. Conclusions: The ratio of dental occlusion and class III maxillo-mandibular skeletal relationship are corrected with the use of a twin block appliance, besides being a therapeutic choice that improves dysfunction of the temporomandibular joint and facial esthetics in patients with this dentomaxillofacial anomaly.

Assessment of facial analysis measurements by golden proportion / Avaliação das medidas de análise facial pela proporção áurea

Abstract Introduction: The face is the most important factor affecting the physical appearance of a person. In facial aesthetics, there is a specific mathematical proportion, which is called golden proportion, used to measure and analyse facial aesthetic qualities in population. Objectives: The aim of this study was to measure the facial soft tissue proportions which would help to constitute a standard for facial beauty and diagnose facial differences and anomalies and to compare these proportions to the golden proportion. Methods: One hundred and thirty-three (133) Turkish patients 18-40 years of age (61 females, 72 males) were involved in the study. Analysis of the photographs was performed by the same physician, and a software programme was used (NIH Image, version 1.62). Facial proportions were measured and differences from the golden proportions were recorded and grouped as normal (1.6-1.699), short (<1.6) and long (>1.699). Results: According to the facial analysis results, the trichion-gnathion/right zygoma-left zygoma was assessed: 33.1% of the patients were in normal facial morphology, 36.8% were in long facial morphology and 30.1% were in short facial morphology, according to this proportion. The trichion-gnathion/right zygoma-left zygoma proportion was significantly higher in males than females (p < 0.001). Statistically significant difference was noted in gender groups, according to the trichion-gnathion/right zygoma-left zygoma and the right lateral canthus-left lateral canthus/right cheilion-left cheilion proportions (p = 0.001, p = 0.028). Conclusion: Facial proportion assessments in relation to the golden proportion showed that a statistically significant difference was observed between gender groups. Long facial morphology was observed more in males (51.4%); normal (41%) and short (39.3%) facial morphology were more common in females. The measurements and proportions for facial balance in our study population showed that the facial width and height proportions deviated from the golden proportion.

Resumo Introdução: A face é o aspecto mais importante da aparência física de uma pessoa. Na estética facial, existe uma proporção matemática específica, chamada de proporção áurea. A proporção áurea é usada para medir e analisar as qualidades estéticas da face na população. Objetivo: Medir as proporções dos tecidos moles faciais que contribuem para o padrão da beleza facial, auxiliar a percepção e o diagnóstico das diferenças e anomalias faciais e comparar essas proporções com a proporção áurea. Método: Foram incluídos no estudo 133 pacientes turcos com 18 a 40 anos (61 mulheres, 72 homens). A análise das fotografias foi realizada pelo mesmo médico e um programa de software foi usado (NIH Image, versão 1.62). As proporções faciais foram medidas e as diferenças das proporções áureas foram registradas e agrupadas como normais (1,6-1,699), curtas (< 1,6) e longas (> 1,699). Resultados: De acordo com os resultados da análise facial, avaliou-se a proporção do tríquion-gnátio/zigoma direito-zigoma esquerdo e 33,1% dos pacientes apresentaram morfologia facial normal, enquanto 36,8% tinham morfologia facial longa e 30,1% morfologia facial curta, segundo essa proporção. A proporção do tríquion-gnátio/zigoma direito-zigoma esquerdo foi significantemente maior em homens do que em mulheres (p < 0,001). Uma diferença estatisticamente significante foi observada entre os sexos, de acordo com a proporção do tríquion-gnátio/zigoma direito-zigoma esquerdo e do canto lateral direito-canto lateral esquerdo/ângulo cantal direito- ângulo cantal esquerdo (p = 0,001, p = 0,028). Conclusão: A avaliação da proporção facial em relação à proporção áurea mostrou que houve diferença estatisticamente significante entre os sexos. A morfologia facial longa foi mais observada no sexo masculino (51,4%), a morfologia facial normal (41%) e a curta (39,3%) foram mais comuns no sexo feminino. As medidas e proporções para o equilíbrio facial em nossa população estudada mostraram que as proporções de largura e altura faciais se desviaram da proporção áurea.

Important aspects to consider in facial analysis for Orthognatic Surgery / Aspectos importantes a considerar en el análisis facial para la Cirugía Ortognática

The process of facial analysis for orthognathic surgery has become of utmost importance over the last several decades, many studies show that the correction of occlusion in a dentofacial deformity does not always reach the desired facial proportions. There is no face completely symmetrical; However, the absence of some asymmetry is essential for an aesthetic outcome. Moreover, the perfect understanding of the face balance prior to treatment is critical to obtain the success of the treatment plan. Thus, the search for facial harmony requires an organized process of facial evaluation; which we intend to address in this article.

El proceso de análisis facial para la cirugía ortognática se ha vuelto de suma importancia en las últimas décadas, muchos estudios muestran que la corrección de la oclusión en una deformidad dentofacial no siempre alcanza las proporciones faciales deseadas. No hay rostro completamente simétrico; sin embargo, la ausencia de alguna asimetría es esencial para un resultado estético. Además, la comprensión perfecta del equilibrio facial antes del tratamiento es fundamental para obtener el éxito del plan de tratamiento. Por lo tanto, la búsqueda de armonía facial requiere un proceso organizado de evaluación facial; que intentamos abordar en este artículo.

Principales causas relacionadas con el abandono del tratamiento ortodóncico por escolares y adultos jóvenes según tipos de aparatos utilizados / Main causes related to the orthodontics treatment cessation by school children and young adults according to types of braces used

Se realizó un estudio epidemiológico analítico, de casos y controles, para identificar los principales factores asociados al abandono del tratamiento ortodóncico en el Servicio de Ortodoncia de la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, en el período comprendido desde septiembre de 2010 hasta julio de 2013. Para ello se crearon 2 grupos: el de los casos, integrado por 193 pacientes de uno u otro sexo, que habiendo iniciado el tratamiento ortodóncico en 2008 por presentar maloclusiones, lo abandonaron en 2010; y el de los controles, conformado por 193 que lo comenzaron también en 2008, pero lo finalizaron en 2010 o 2011. Se determinaron los odds ratio y los intervalos de confianza al 95 por ciento para los factores, en tanto mostraron la mayor fuerza de asociación al abandono del tratamiento: sexo masculino, 6 y más consultas no asistidas y 6 y más consultas pérdidas por falta de recursos. Los principales factores que se asociaron causalmente al abandono del tratamiento ortodóncico fueron los escolares, el sexo masculino, el menor nivel de escolaridad, aparatos removibles y funcionales, aparatos removibles rotos y/o perdidos, consultas entre el ingreso y la instalación de los aparatos y las consultas perdidas por falta de recursos

An analytic epidemiological cases and controls study was carried out, to identify the main factors associated with the orthodonctics treatment cessation in the Orthodontics Service of "Mártires del Moncada" Teaching Provincial Stomatological Clinic in Santiago de Cuba, from September, 2010 to July, 2013. Two groups were created: the cases group, integrated by 193 patients from both sexes that began the orthodontics treatment in 2008 due to malocclusions, and quit it in 2010; and the controls group, conformed by 193 that also began in 2008, but they concluded it in 2010 or 2011. The odds ratio and confidence intervals were determined at 95 percent for the factors, as long as they showed the highest force of association when quitting the treatment: the male sex, 6 and more missed visits and 6 and more lost visits due to lack of resources. The main factors that were causally associated with the orthodontics treatment cessation were the school children, the male sex, the lowest school level, removable and functional braces, broken and/or lost removable braces, visits between admission and teeth bracing and lost visits due to lack of resources

Subcutaneous lateral brow lift, an option with local anesthesia / Levantamiento de cejas lateral con acceso subcutáneo, una opción con anestesia local

The aim of this article is to present a case series of subcutaneous lateral brow lifts withlocal anesthesia. The case series includes 9 subjects operated on between 2014 and 2016, with an averageage of 57 years and with no limitations on ethnic group or gender. The surgery was done bilaterally entirelyunder local anesthesia. After a minimum follow-up of 3 months, no major complications were observed, onlypartial suture dehiscence at two surgical sites that did not require surgical management of the zone. Goodresults were established, being fast, economical and with low morbidity. It is concluded that the subcutaneousbrow lift with local anesthesia can be applied with a low rate of complications and good results.

El objetivo de este articulo es presentar una serie de casos operados para levantamiento lateral de cejas, con disección subcutánea y con uso de anestesia local. Se diseño un estudio de serie de casos, incluyendo 9 sujetos operados entre el año 2014 y 2016, con una edad promedio de 57 años y sin restricción de etnia o sexo. Se realizó la cirugía totalmente bajo anestesia local de forma bilateral. Después de un seguimiento mínimo de 3 meses, no se observaron complicaciones mayores, presentado solo dehiscencia parcial de sutura en dos sitios quirúrgico que no requirieron manejo quirúrgico de la zona; se establecieron buenos resultados, siendo ellos rápidos, de baja morbilidad y de bajo costo. Se concluye que la técnica de levantamiento de cejas con disección subcutánea y anestesia local puede ser aplicado con bajo índice de complicaciones y buenos resultados.

Principales factores de riesgo relacionados con el abandono del tratamiento ortodóncico por escolares, adolescentes y adultos jóvenes / Main risk factors related to the orthodontics treatment cessation for school children, adolescents and young adults

Se realizó un estudio epidemiológico analítico, de casos y controles, para identificar los principales factores asociados al abandono del tratamiento ortodóncico en el Servicio de Ortodoncia de la Clínica Estomatológica Provincial Docente "Mártires del Moncada" de Santiago de Cuba, en el período comprendido desde septiembre de 2010 hasta julio de 2013. Para ello se crearon 2 grupos: el de los casos, integrado por 193 pacientes de uno u otro sexo, que habiendo iniciado el tratamiento ortodóncico en 2008 por presentar maloclusiones, lo abandonaron en 2010; y el de los controles, conformado por 193 que lo comenzaron también en 2008, pero lo finalizaron en 2010 o 2011. Entre las variables utilizadas figuraron: edad, sexo, escolaridad y consultas no asistidas. Se obtuvo un predominio de los varones (55,4 %), del abandono del tratamiento por los escolares (72,0 %), del menor nivel de escolaridad (88,6 %) y de la asistencia a menos de 6 consultas (54,9 %).

An analytic epidemiological, of cases and controls study, to identify the main factors associated to the orthodontics treatment cessation in the Orthodontics Service of "Martires del Moncada" Teaching Provincial Stomatological Clinic in Santiago de Cuba, was carried out from September, 2010 to July, 2013. Two groups were formed: the cases, integrated by 193 patients from both sexes that began the orthodontics treatment in 2008 due to malocclusions, and quit it in 2010; and the controls group, conformed by 193 that also began in 2008, but they concluded it in 2010 or 2011. Among the used variables there were: age, sex, school level and missed visits. A prevalence of males (55.4 %), school children treatment cessation (72.0 %), the lowest school level (88.6 %) and the attendance to less than 6 visits (54.9 %) was obtained.

Fonoaudiología y estética facial: experiencia de Brasil en la atención primaria de salud / speech therapy and facial esthetic: experience of Brazil in primary health care

La fonoaudiología es una disciplina relativamente nueva en Chile por lo cual se encuentra en pleno proceso de crecimiento y desarrollo. En este contexto, en el área de Motricidad Orofacial ha surgido hace algunos años una subespecialidad denominada “estética facial” que aborda la musculatura facial y sus alteraciones, ya sean secundarias al proceso natural de envejecimiento y/o a factores externos. Brasil, país pionero en esta práctica, ha desarrollado diversos planes de intervención en salud. A través de la creación de Núcleos de Apoyo a la Salud de la Familia, se ha incluido la estética facial en el contexto de atención primaria de salud. Es así que en la ciudad de Sete Lagoas, Minas Gerais se ha desarrollado un programa de estética facial con el objetivo de fomentar la integración del cuidado físico y mental de los usuarios. La evidencia científica muestra los resultados de la fonoaudiología estética, relajando la musculatura facial, disminuyendo arrugas y líneas de expresión y mejorando la sensación de bienestar de las personas. Se plantea la importancia de ampliar el conocimiento del profesional fonoaudiólogo chileno y desarrollar nuevas áreas de desempeño para contribuir en el beneficio de la población...

Speech Therapy is relatively new discipline in Chile, therefore, it is in the process of growth and development. As part of the orofacial motricity area, a new specialty has began to develop: Facial esthetic. This new area deals with facial muscles and their alterations caused by natural aging processes and/or external factors. Brazil, a pioneer country in this practice, has developed several health intervention plans. In this respect, facial esthetic has been included in the context of primary health care, through the creation of Family Health Support Centers. For instance, a program of facial esthetic has been implemented in the city of Sete Lagoas, Minas Gerais. This program aims to promote the integration of physical and mental care. Scientific evidence shows that esthetic’s speech therapy produce relaxation of facial muscles, reducing wrinkles and fine lines and improving the people’s sense of well-being. Therefore, increasing the knowledge about this area in Chilean speech therapists and developing new areas of professional performance would be important issues to address...

Recuperación de la autoestima en una adulta mayor rehabilitada con prótesis dental / Recovery of self-esteem in a female elderly rehabilitated with dentures

Se describe el caso clínico de una paciente de 67 años de edad, asistida en la Clínica Estomatológica del Policlínico Docente "Camilo Torres Restrepo" de Santiago de Cuba, quien había portado, por más de 10 años, prótesis superior acrílica desajustada, y además refería haber disminuido de peso corporal por la presencia de importantes dificultades masticatorias y dolor ocasional en las articulaciones temporomandibulares; asimismo, la afectada mostraba inconformidad con su estética facial. Todo lo anterior había dañado su autoestima y, consecuentemente, le producía limitaciones sociales en los planos laboral y personal. La paciente fue rehabilitada con prótesis total superior acrílica y parcial inferior acrílica, con lo cual mejoraron su estética y la función masticatoria. Fue remitida a consulta de Fisioterapia para completar el tratamiento del trastorno articular.

The case report of a 67 years patient is described, attended in the Stomatological Clinic from "Camilo Torres Restrepo" Teaching Polyclinic in Santiago de Cuba who had wore maladjusted acrylic upper denture for more than 10 years, and besides she referred to have lost of body weight due to important masticatory difficulties and occasional pain in the temporomandibular joints; likewise, the patient showed disagreement with her facial aesthetics. All the above-mentioned facts had damaged her self-esteem and, consequently, she showed social limitations in the working and personal fields. The patient was rehabilitated with upper total acrylic and partial lower acrylic prosthesis, with which her aesthetics and the masticatory function improved. She was referred to the Physiotherapy department to complete the treatment of the joint dysfunction.

Influencia del índice de masa corporal en las características faciales de mujeres jóvenes: resultados preliminares / Body mass index influence in facial pattern of young women. preliminary results

La posición y volumen de tejidos blandos de la cara generan la necesidad de una planificación precisa al momento de cirugias faciales; la influencia del tejidos adiposo en estas caracteristicas puede estar presente. El objetivo de este estudio es identificar las medidas volumétricas y no volumétricas de puntos antropométricos faciales y establecer su relación con el índice de masa corporal (IMC). Se analizaron 29 sujetos del sexo femenino de entre 20 y 25 años de edad (promedio de 22,5 años). Se incluyeron sujetos con auto percepcion de normalidad facial y sin condiciones previas asociadas a trauma, cirugia facial u ortodoncia. Se realizó una secuencia de analisis facial realizando medidas con hilo sobre la cara y con pie de metro en los mismos puntos, estudiando distancias entre puntos antropometricos previamente definidos. Inicialmente se realizo el estudio de peso y talla de los sujetos mediante condiciones estandarizadas. En la tercera etapa se realizaron radiografías laterales en cada sujeto realizando mediciones sobre la radiografia para identificar el tejido blando presente en la región labio superior e inferior, punto A, punto B y pogonion. El analisis de datos se realizo con t test de muestras relacionadas, considerando un valor de p 0.05; el análisis estadístico ANOVA se utilizó para definir la influencia del IMC sobre las variables estudiadas. El peso obtenido registró un promedio de 57,6 kg (+/-8,3 kg) y la talla presento un promedio de 1,6mt; el IMC obtenido fue de 22,5, registrándose 2 sujetos considerados en peso inferior al normal, 20 con peso normal, 6 en sobrepeso y 1 con obesidad. Se observo que las variables volumetricas fueron diferentes a las variables no volumetricas de la cara y se asociaron significativamente con el IMC. El IMC no presento relación positiva con las mediciones realizadas en radiografias laterales; finalmente el IMC tambien no se asocio a la auto percepcion de estética facial (p=0.069)...

The position and volume of the face soft-tissue yield the necessity of a precise plan at the facial surgery time; the influence of the adipose tissue on these characteristics can be present. The aim of this study is to identify the volumetric and non-volumetric measures of anthropometrics facial points and his relationship with the Body Mass Index (BMI). It was been analyzed 29 female subjects between 20 and 25 years old (mean 22.5 years). It was include subjects with self-perception of facial normalcy and without conditions associated to trauma, facial surgery or orthodontic treatment. It was made a sequence of facial analysis measuring with a thread over the face and a caliper the same points, studying distances between anthropometrics points previous define. Previously, it was made a study of the weight and size of the subjects, through standards conditions. At the third stage it was made lateral radiographs to identify the soft tissue present at the superior and inferior lip region, point A, point B and Pogonion. The data analysis was made with the t test of relationship samples, considering a p value 0.05; the statistics analysis ANOVA was used to define the influence of the BMI over the variables. The weight registered a mean of 57.7 kg (+/-8,3 kg) and the size performed a mean of 1.6 m.; the BMI acquired was 22.5, registering, being 2 subjects considerate inferior to the normal weight, 6 overweight and 1 obesity. It was seem that the volumetric variables were different to volumetric variables of the face and they were associated significantly with the IMC. The IMC didn´t show positive relationship with the measures made on the laterals radiographies; finally, the BMI, as well, did not associate to the self-perception of facial aesthetic (p=0.069). It is possible to conclude that the BMI influence the measures obtained on the face and did not influence on the register made over the laterals radiographs.

Análisis facial, dentario y radiográfico de la normalidad facial: estudio piloto en 29 mujeres / Facial, dental and radiographic analyses of facial normality: a pilot study in 29 women

La estética y armonía facial se relacionan de forma directa con la percepción y autoestima de los individuos; muchas veces se generan deseos de cambios estéticos por medio de cirugías para obtener una valoración positiva de sí mismo. El objetivo de este estudio fue investigar la relación entre la percepción, autoestima y deseo de cambio estético; y puntos antropométricos, cefalométricos y maloclusiones de un grupo de mujeres. Se escogieron 29 mujeres chilenas, entre 20 y 25 años de edad, en las cuales se realizó una encuesta sobre la autoestima, autopercepción de normalidad facial, deseo de cambio estético y cambio de autoestima posterior a una cirugía, éstas se asociaron a través de un análisis de chi2, regresión logística de multivariado y ANOVA, con las distancias entre puntoantropométricos objetivos basados en estudios de Farkas y entre puntos cefalométricos basados en Epker y Fish; y entre ellas a través de un análisis. La normalidad facial se ve afectada principalmente por clases caninas derecha (p=0,02) e izquierda (p=0,015) y molares derecha (p=0,015) e izquierda (p=0,04); y además el apiñamiento dentario (p=0,012). Mientras el aumento en la distancia de exocantios (p=0,04), bases alares (p=0,03), proporción glabela subnasal y subnasal mentón (p=0,02) se asocian a una percepción de anormalidad. La autoestima puede variar de forma positiva posterior a un cambio estético, a través de cirugía o tratamiento de ortodoncia. Los parámetros dentomaxilares y craneofaciales son determinantes en la percepción de normalidad estética de estas mujeres, siendo los relacionados con nariz y altura facial los de mayor influencia en este estudio. Son necesarios futuros estudios para evaluar autoestima, autopercepción de normalidad facial y proporciones estéticas.

Aesthetics and facial harmony are directly related to self-esteem and perception individuals have of themselves. There is often a desire to make overall aesthetic changes through surgery in order to get a positive assessment of oneself. The aim of this study was to research the relationship between perception, self-esteem and desire for change; and points aesthetic anthropometric and cephalometric points, as well as malocclusions in a group of women. Twenty nine (29)Chilean women between 20 and 25 years of age were chosen, taking part in a survey on self-esteem, self-perception of facial normalcy, the desire for aesthetic change, and changes of self-esteem following surgery. These were subsequently associated through Chi2 analysis, logistic multi variant regression and ANOVA, with distances between objective anthropometric marks based on Farkas research, and between cephalometric points based in Epker and Fish study. Facial normalcy seems mainly affected by right canine class (p=0.02), and left (p=0.015); right molar class (p=0.015) and left (p=0.04), as well as dental crowding (p=0.012). While greater exocanthion distance (p=0.04), alar base (p=0.03), subnasal glabella and subnasal menton ratios (p=0.02), are related to a perception of abnormality. Self esteem perception can vary in positive ways following an aesthetic change through surgery or orthodontic treatment. Dental, maxillary and craniofacial parameters are determinants of the aesthetic normalcy perception of these women, with nose and facial height having the most influence in this study. Further research is necessary to evaluate self- esteem and self perception of facial normalcy, as well as aesthetic ratios.

O impacto das próteses implantossuportadas na harmonia facial / The impact of implant-supported prostheses in facial harmony

Grande parte da população que procura atendimento odontológico deseja melhorar a estética facial e a do sorriso, para ser inserida na sociedade em que vive. Nos indivíduos usuários de próteses totais, a reabsorção fisiológica causa uma atrofia, principalmente da maxila, sendo necessária a realização de técnicas reconstrutoras e, às vezes, de movimentação das bases ósseas, para maior estabilidade oclusal e harmonia facial. O objetivo deste trabalho foi abordar as características relacionadas com a reabilitação dos pacientes edêntulos, com indicação para a reconstrução dos maxilares com enxerto ósseo e cirurgia ortognática, por meio de um caso clínico. Sendo que após a reabilitação com as próteses implantossuportadas, a paciente se mostrou amplamente satisfeita com o resultado estético-funcional alcançado e se recusou a submeter-se à cirurgia ortognática proposta no planejamento. Com isso, os profissionais devem apresentar as opções terapêuticas aos pacientes, porém, deve prevalecer a queixa principal dos mesmos, desde que seja uma modalidade de tratamento viável.

Many patients seeking dental care wish to improve facial and smile aesthetics to be accepted in modern day society. In denture wearers, the physiological resorption causes atrophy mainly in the maxilla, being necessary to carry out reconstruction techniques and sometimes orthognathic surgery to improve occlusal stability and facial harmony. The aim of this study is to discuss the features related to the rehabilitation of edentulous patients with indication for reconstruction of the maxilla using bone grafts and orthognathic surgery by means of a clinical case. In the present case, after the prosthetic rehabilitation, the patient was full satisfied with obtained results and dismissed the initially proposed surgical protocol. Therefore, professionals should provide therapeutic options but the patient’s opinion should prevail provided its clinical feasibility.

Resolución de una distoclusión severa / Resolution of a severe distocclusion

El objetivo del presente estudio es mostrar el caso clínico de un paciente de sexo masculino de 20 años de edad con una distoclusión severa y principalmente,una gran demanda estética. Pese a sus limitaciones, el tratamiento se realizó con éxito, logrando como resultado un considerable aumento en la autoestimadel paciente. La estética facial es el resultado del equilibrio y armonía de las simetrías y proporciones resultantedel estudio morfológico facial. La belleza de un rostro se correlaciona con el grado de autoestima, salud ybienestar del paciente (1). Los estudios estéticos cobran cada vez mayor importancia por la gran demanda de la sociedad actual. Pero además porque no solo incluye alteraciones funcionales, dentales y esqueléticas sino también delos tejidos blandos.

Study of face pleasantness using facial analysis in standardized frontal photographs

OBJECTIVE: The purpose of this research was to check if the numeric facial analysis can determine facial attractiveness. METHOD: The sample consisted of frontal and lateral standard facial photographs, in natural head position, of 85 Brazilian Caucasian women, without facial plastic surgery report. The sample mean age was 23 years and 9 months. A group of 5 orthodontists, 5 layman and 5 plastic artists classified the photographs according to their own attractiveness graduation in: pleasant, acceptable and not pleasant. The numeric facial analysis was then performed using a computerized method. Linear, proportional and angular measurements were compared among groups. RESULTS: According subjective analysis the sample was consisted of 18.8% of pleasant, 70.6% of acceptable and 10.6% of not pleasant. In most measurements there were no differences among groups. Just in three of them significant statistical difference was observed and in two of them the comparison value was within decision limit. All the differences found were related to the lower third of the face and to facial pattern. CONCLUSION: On the present research, the numeric facial analysis, by itself, was not capable of detecting facial attractiveness, considering that beauty judgment seems to be very personal.

OBJETIVO: esse estudo foi desenvolvido com o propósito de verificar se a análise facial numérica realizada em fotografias frontais é sensível em detectar a atratividade da face. MÉTODOS: a amostra foi composta por fotografias faciais padronizadas, frontais e laterais, em posição natural da cabeça, de 85 mulheres brasileiras, leucodermas, com idades entre 18 e 30 anos, sem histórico de cirurgia plástica facial. A idade média da amostra foi de 23 anos e 9 meses. As fotografias foram classificadas de acordo com o grau de atratividade da face por uma banca composta de cinco especialistas em Ortodontia, cinco leigos e cinco artistas plásticos. A partir dessa classificação, os indivíduos foram divididos em três grupos: esteticamente agradáveis, esteticamente aceitáveis e esteticamente desagradáveis. Em seguida, foram realizados os traçados fotométricos por meio computadorizado. As médias das variáveis lineares, proporcionais e angulares propostas foram comparadas estatisticamente entre os grupos. RESULTADOS: pela análise subjetiva, 18,8% da amostra foram classificados como esteticamente desagradáveis, 70,6% como esteticamente aceitáveis e 10,6% como esteticamente agradáveis. Na maioria das variáveis, não observou-se diferenças entre os grupos. Em apenas três delas houve diferenças estatisticamente significativas. Todas as diferenças encontradas relacionaram-se ao terço inferior da face e ao padrão facial. CONCLUSÃO: no presente estudo, a análise facial numérica utilizada isoladamente não foi sensível na detecção de padrões de atratividade, já que os critérios de beleza parecem ser altamente subjetivos.

Estética y ortodoncia / Esthetics and orthodontics

En este artículo se realiza un análisis de estética facial y de los elementos que conforman la sonrisa. Esto debe ser parte integral de un estudio en ortodoncia.