Extração assimétrica em indivíduo com má oclusão do Padrão Face Longa: relato de caso / Asymmetric extraction individual with Long Face Pattern malocclusion: case report

Desde o início da Ortodontia extrações dentárias podem ser a melhor opção em algumas situações clínicas. A extração dentária de forma assimétrica tem sido utilizada por vários autores e, quando bem indicada, tem alcançado ótimos resultados. Devido à exiguidade dos limites ósseos em indivíduos do Padrão Face Longa, o tratamento é bastante limitado pela contra indicação para grandes movimentações dentárias, razão pela qual procura-se respeitar e manter a posição inicial dos dentes. Nesse contexto, o presente artigo tem por objetivo apresentar o tratamento individualizado de um paciente adulto jovem, Padrão Face Longa, subtipo moderado, tratado de modo compensatório, com extração assimétrica dos dentes 13 e 24. A simplificação da mecânica permitiu eliminar a excrescência, sem perdas funcionais e biológicas e com melhora estética.

Dental extraction has always been a topic of discussion since the very beginning of orthodontics studies. Several authors have been using asymmetric extractions and reaching great results when that is prudently recommended. The treatment is very limited in long-faced individuals, moderate subtype, because of bone structure limitations so it is usually suggested to avoid moving much the teeth in this case, respecting as much as possible their initial position. Having considered that, this article aims to present an individualized treatment of a young adult patient, long face pattern, moderate subtype, to be treated with compensation method, extracting teeth 13 and 24. The result was successful where the excrescence was eliminated without losing functional and biological features while achieving a mechanical simplification and aesthetic gains.

Prevalence of long face pattern in Brazilian individuals of different ethnic backgrounds

Objective: The long face pattern is a facial deformity with increased anterior total facial height due to vertical excess of the lower facial third. Individuals with long face may present different degrees of severity in vertical excess, as well as malocclusions that are difficult to manage. The categorization of vertical excess is useful to determine the treatment prognosis. This survey assessed the distribution of ethnically different individuals with vertical excess according to three levels of severity and determined the prevalence of long face pattern. Material and Methods: The survey was comprised of 5,020 individuals of Brazilian ethnicity (2,480 females and 2,540 males) enrolled in middle schools in Bauru-SP, Brazil. The criterion for inclusion of individuals with vertically impaired facial relationships was based on lip incompetence, evaluated under natural light, in standing natural head position with the lips at rest. Once identified, the individuals were classified into three subtypes according to the severity: mild, moderate, and severe. Then the pooled sample was distributed according to ethnical background as White (Caucasoid), Black (African descent), Brown (mixed descent), Yellow (Asian descent) and Brazilian Indian (Brazilian native descent). The Chi-square (χ 2 ) test was used (p<0.05) to compare the frequency ratios of individuals with vertically impaired facial relationships in the total sample and among different ethnicities, according to the three levels of severity. Results: The severe subtype was rare, except in Black individuals (7.32%), who also presented the highest relative frequency (45.53%) of moderate subtype, followed by Brown individuals (43.40%). In the mild subtype, Yellow (68.08%) and White individuals (62.21%) showed similar and higher relative frequency values. Conclusions: Black individuals had greater prevalence of long face pattern, followed by Brown, White and Yellow individuals. The prevalence of long face pattern was 14.06% in which 13.39% and 0.68% belonged to moderate and severe subtypes, respectively.

Proposta para classificação, segundo a severidade, dos indivíduos portadores de más oclusões do Padrão Face Longa / Proposal for classification of individuals with long face pattern malocclusions according to severity

OBJETIVO: o presente estudo teve como objetivo propor um método para classificação, segundo a severidade, dos indivíduos Padrão Face Longa, avaliando sua confiabilidade e reprodutibilidade. METODOLOGIA: foram utilizadas fotografias faciais (frontal, perfil e frontal sorrindo) de 125 crianças Padrão Face Longa (54 do gênero feminino e 71 do gênero masculino), selecionadas apenas considerando-se a morfologia facial, com idades entre 10 anos e 6 meses e 15 anos e 2 meses. As fotografias foram avaliadas, separadamente, por três examinadores, sendo reavaliadas após três semanas, em uma nova disposição aleatória. Os indivíduos foram graduados em três subtipos, de acordo com a severidade: moderado, médio e severo. Para avaliar as concordâncias intra e interexaminadores, foi utilizada a estatística Kappa (k). RESULTADOS: na avaliação intra-examinador, todos os examinadores obtiveram concordâncias substanciais, com o valor de Kappa variando de 0,64 a 0,66, havendo em todos os examinadores 80 por cento ou mais de concordância. Quando comparadas as avaliações interexaminadores, as freqüências de concordância diminuíram, variando de 67,2 por cento a 70,4 por cento. A partir dos valores de Kappa, que variaram de 0,41 a 0,46, a interpretação foi considerada moderada. CONCLUSÕES: com base nesses resultados, o método foi considerado aplicável, com necessidade de complemento de informações provenientes de outros exames rotineiramente aplicados em Ortodontia. A aplicação clínica será demonstrada com intuito de evidenciar os níveis diferentes de severidade das más oclusões do Padrão Face Longa e as características do protocolo de tratamento recomendado.

AIM: The present study aimed to propose a method for classification of long-face patients according to severity, evaluating its reliability and reproducibility. METHODS: The study was conducted on facial photographs (frontal, profile and smiling frontal) of 125 long-face children (54 females and 71 males) aged 10 years and 6 months to 15 years and 2 months, selected only on the basis of facial morphology. The photographs were separately evaluated by three examiners and re-evaluated after three weeks in a different random order. The individuals were divided into three subtypes according to severity as mild, moderate and severe. Intra- and inter-examiner agreement was assessed by Kappa (k) statistics. RESULTS: Intra-examiner evaluation revealed substantial agreement, with Kappa values ranging from 0.64 to 0.66 and 80 percent or more agreement for all examiners. Evaluation of inter-examiner agreement revealed lower values, ranging from 67.2 percent to 70.4 percent, with Kappa values of 0.41 to 0.46, thus indicating moderate agreement. CONCLUSIONS: Based on these results, the method was regarded as applicable, yet it should be complemented with further information from other examinations routinely applied in Orthodontics. Clinical application will be demonstrated to highlight the different degrees of severity of long face pattern malocclusions and the characteristics of the recommended treatment protocol.