Métodos para determinación del plano oclusal / Methods for determination of the occlusal plane

Para el rehabilitador oral, resulta fundamental determinar con precisión la orientación del plano oclusal en pacientes con distintas alteraciones, como desgastes severos, edentulismo parcial, total y sus consecuencias. Es importante que este sea lo más cercano posible a la posición que ocupaba en dentición natural, ya que influye principalmente en la función oclusal, de los músculos masticatorios, en la articulación temporomandibular, en la fonética y en la estética. Además, la correcta determinación constituye la base de la planificación, por ser el plano de referencia estético y funcional; determina la guía anterior, los patrones de movimiento mandibular, la eficiencia masticatoria y la dimensión vertical. Por ello, el propósito de este estudio es evaluar los métodos más utilizados y confiables para la determinación del plano oclusal, mediante una revisión de la literatura científica actual. A partir de lo investigado, se concluye que el plano oclusal debe ubicarse en la posición que ocupaban los dientes naturales, y su determinación incluye una secuencia clínica, que se inicia por el sector anterior en reposo y sonrisa, y continúa con el sector posterior. No existe un método absoluto. Es importante el análisis individual de cada paciente para decidir qué métodos serán los más indicados. Existen métodos que incluyen el análisis cefalométrico o tridimensional, lo que aporta una mayor precisión en la planificación. (AU)

In oral rehabilitation, it is fundamental to accurately determine the orientation of the occlusal plane in patients with different occlusal alterations such as severe wear, partial and total edentulism and their consequences. It is important that the occlusal plane be as close as possible to the position occupied in natural dentition, since it mainly affects occlusal function, the masticatory muscles, the temporomandibular joint, phonetics and aesthetics. In addition, correct determination is the basis of treatment planning, as it is the aesthetic and functional reference plane, and determines the previous guide, mandibular movement patterns, masticatory efficiency and vertical dimension. Thus, the purpose of this study was to provide a review of the current scientific literature on the most commonly used and reliable methods for determining the occlusal plane. According to the literature, the occlusal plane should be located in the position occupied by the natural teeth, and its determination is made following a clinical sequence starting with the anterior sector at rest and while smiling, continuing with the posterior sector. There is no method of choice. However, individual analysis of each patient is important to determine the most adequate method. Methods including cephalometric and/or three-dimensional analysis provide greater precision for treatment planning. (AU)

Análise bi e tridimensional das vias aéreas superiores em pacientes submetidos à cirurgia ortognática bimaxilar / Two- and three-dimensional analysis of the upper airways in patients undergoing bimaxillary orthognathic surgery

O propósito deste trabalho foi analisar as mudanças bi e tridimensionais na via área superior após procedimentos de cirurgia ortognática. Tomografias pré (T1) e pós-operatórias (T2) foram utilizadas, padronizando pontos craniométricos que serviram de referência para analisar mudanças lineares e volumétricas de diferentes áreas na via aérea superior. Vinte e dois pacientes foram incluídos no estudo, tendo sido submetidos a cirurgia bimaxilar com alteração do plano oclusal. Todos os casos foram planejados virtualmente, e o software Dolphin Imaging (versão 11.9) foi utilizado para análise das medidas lineares, bem como, o cálculo da área da via área superior total, e de suas 3 subdivisões e da região de maior constrição. A via aérea posterior e superior total, foi beneficiada com os movimentos de avanço das cirurgias bimaxilares. Houve correlação positiva entre o valor da constrição pré e pós e o valor total 3D da via aérea pré e pós. Observou-se diferença significativa quando se avalia a média Pré e Pós do seguimento de via aérea total (ST) bi e tridimensionalmente. Encontrou-se uma correlação positiva entre o giro anti-horário do plano oclusal e a ampliação da via aérea. Não foi possível determinar com precisão como cada ponto craniométrico individualmente influenciou e/ou contribui para as mudanças em cada segmento da via aérea analisada. Com bases nos dados da pesquisa a cirurgia ortognática bimaxilar demonstrou aumento das dimensões da via aérea superior, apresentando comportamentos diferentes a depender do segmento da via aérea superior avaliado, e da sua relação com os movimentos dos pontos craniométricos (AU).

The purpose of this work aimed to analyze the bi and three-dimensional changes in the upper airway after orthognathic surgery procedures. Pre (T1) and postoperative (T2) CT scans were used, standardizing craniometric points that served as a reference to analyze linear and volumetric changes in different areas in the upper airway. Twenty-two patients were included in the study, having undergone bimaxillary surgery with alteration of the occlusal plane. All cases were planned virtually, and the Dolphin Imaging software (version 11.9) was used to analyze the linear measurements, as well as the calculation of the area of the total upper area, and its 3 subdivisions and the region most significant. The posterior and upper total airways benefited from the advancing movements of bimaxillary surgeries. There was a positive correlation between the pre and post constriction value and the total 3D value of the pre and post airway. A significant difference was observed when evaluating the pre and post average of the total airway (ST) bi and three-dimensional follow-up. A positive correlation was found between the counterclockwise rotation of the occlusal plane airway's enlargement of the airway. It was not possible to accurately determine how each craniometric point individually influenced and / or contributed to the changes in each segment of the analyzed airway. Based on the research data, bimaxillary orthognathic surgery demonstrated an increase in the dimensions of the upper airway, showing different behaviors depending on the segment of the upper airway evaluated, and its relationship with the movements of the craniometric points (AU).

Clinical study on the posterior occlusal plane and morphology of temporomandibular joint / Estudio clínico sobre el plano oclusal posterior y la morfología de la articulación temporomandibular

The objective of the study was to investigate the morphological features of the temporomandibular joint in adult patients with posterior occlusal plane and different inclinations. Fifty five skeletal I occlusion patients with average were included, shooting CBCT in the intercuspal position, divided into 3 groups according to OPP-FH angle, and measurement of the temporomandibular joint morphology was calculated with cone beam computed tomography (CBCT) special software Invivo 5.0, Statistical analysis of three groups of data using SPSS23.0. The condyle usually locates in the middle of the fossa, the maximum axial area of the condyle (A) was statistically significant between the group 1 and the group 3. The internal and external diameter (MD) of the condyle was statistically significant between group 1 and group 3, and group 2 and group 3. The bilateral TMJ morphological features of the three groups were basically symmetrical. The position of the condyle in the fossa is mostly centered, and some of the posterior, the maximum axial area and the internal and external diameter of the condyle are different in three groups.

El objetivo de este estudio fue investigar las características morfológicas de la articulación temporomandibular (ATM) en pacientes adultos con plano oclusal posterior y diferentes inclinaciones. Se incluyeron 55 pacientes con oclusión esquelética tipo I, visualizados por tomografía computarizada de haz cónico (CBCT) en posición intercuspiana, y se dividieron en 3 grupos según el ángulo OPP-FH. La medición morfológica de la articulación temporomandibular se calculó con CBCT y mediante el software especial Invivo 5.0. El análisis estadístico de datos se realizó con el software SPSS 23.0. El cóndilo de la mandíbula generalmente se ubica en el centro de la fosa; el área axial máxima del cóndilo de la mandíbula (A) fue estadísticamente significativa entre los grupos 1 y 3. Los datos de los diámetros medial y lateral (DM) del cóndilo de la mandíbula fueron estadísticamente significativos entre los grupos 1 y 3 y los grupos 2 y 3. Las características morfológicas de la ATM de los tres grupos fueron básicamente simétricas. La posición del cóndilo de la mandíbula en la fosa fue principalmente centrada, y parte del área axial máxima, posterior y los diámetros medial y lateral del cóndilo de la mandíbula fueron diferentes en los tres grupos.

Comparação das medidas extraorais com as medidas intraorais na confecção da prótese total / Comparison of the extra-oral measurements with the intra-oral measurements in the manufacture of the total prosthesis

Introdução: o edentulismo é um problema bastante comum, e o conhecimento adequado da anatomia e da fisiologia da cavidade oral é essencial na recuperação e no equilíbrio neuromuscular do sistema estomatognático. O uso das linhas de referência juntamente com o plano oclusal orientam o posicionamento dos dentes artificias, que são utilizados para construção das próteses totais. Objetivo: comparar as medidas extraorais com as intraorais da largura dos dentes anteriores com as medidas das linhas de referências preconizadas na literatura para confecção de uma prótese total. Métodos: estudo do tipo observacional transversal, com amostra não probabilística, com 50 indivíduos de ambos os gêneros, no quais se realizou uma análise dentária e facial com auxílio de fotografias e um paquímetro digital. Resultados: foi observado que, na maioria dos indivíduos, não houve coincidência entre a largura dos dentes e as linhas de referência analisadas, que as mulheres apresentaram menor coincidência entre os dentes e a largura da asa do nariz, quando comparadas com os homens (8,3% e 91,7%, respectivamente), com p = 0,001. Conclusão: as linhas de referência não foram coincidentes com o tamanho dos dentes na maioria dos casos avaliados. (AU)

Introduction: edentulism is a fairly common problem, and adequate knowledge of the anatomy and physiology of the oral cavity is essential in the recovery and neuromuscular balance of the stomatognathic system. The use of reference lines together with the occlusal plane guide the positioning of the artificial teeth, which are used to construct the total dentures. Objective: to compare the extra-oral and intra-oral measurements of the width of the anterior teeth with the measurements of the reference lines recommended in the literature for making a total prosthesis. Methods: cross-sectional observational study with a non-probabilistic sample, with 50 individuals of both sexes, where a dental and facial analysis was carried out using photographs and a digital caliper. Results: it was observed that most of the individuals analyzed did not coincide between the width of the teeth and the reference lines, and that the analyzed women showed less coincidence between teeth and the width of the nose wing when compared with men (8.3% and 91.7%, respectively), with p = 0.001. Conclusion: the reference lines did not coincide with tooth size in most cases analysed. (AU)

Occlusal plane canting: a treatment alternative using skeletal anchorage

ABSTRACT A canted occlusal plane is the cause of unaesthetic smile, and also represents a challenge, due to the complex orthodontic procedures involved in its treatment. The skeletal anchorage allows successful treatment of this asymmetry in the majority of cases, with less dependency on the patient cooperation and reducing the necessity of orthognatic surgery. Given this condition, this article aims at discussing the main aspects related to the diagnosis of occlusal plane canting, treatment plan, and orthodontic mechanics using skeletal anchorage either by mini-implants or miniplates. In this context, five cases will be reported, showing the main details related to the orthodontic mechanics used to correct the occlusal plane, avoiding side effects and successfully reaching treatment objectives and long-term stability.

RESUMO O plano oclusal inclinado é causa de um sorriso esteticamente desagradável e representa um desafio, devido à complexidade dos procedimentos ortodônticos envolvidos no seu tratamento. A ancoragem esquelética permite a correção da inclinação do plano oclusal, na maior parte dos casos, sem a necessidade de cirurgia ortognática e com menor dependência da colaboração dos pacientes. Com base nisso, o objetivo desse artigo é discutir os principais aspectos relacionados ao diagnóstico, plano de tratamento e mecânica ortodôntica envolvida no tratamento do plano oclusal inclinado com mini-implantes ou miniplacas. Nesse contexto, cinco casos serão apresentados, demonstrando os principais detalhes relacionados à mecânica utilizada na correção do plano oclusal inclinado com a utilização de ancoragem esquelética.

Morphological characteristics of soft tissue profile of Angle's class II division i malocclusion before and after orthodontic treatment / Características morfológicas del perfil de tejido blando de la clase II de la división I de maloclusión de ángulo antes y después del tratamiento de ortodoncia

SUMMARY: By analysing cephalometrics before and after the treatment of Angle's class II division 1 malocclusion, soft tissue profile changes were observed, and to explore whether there was a correlation between the change of posterior occlusal plane (OP-P) and soft tissue profile. The study aimed to provide a theoretical reference in the clinical diagnosis and orthodontic treatment of early permanent dentition of Angle class II division 1 malocclusion patients. We randomly selected 20 cases of orthodontics in Shanxi Medical University orthodontics patients (aged 12-18 years) of the lateral cephalograms, Winceph 8.0 software was used to measure the posterior occlusal plane (OP-P), TUL-EP, TLL-EP, nasolabial angle, upper lip base thickness, upper lip tension, lower lip H line distance, chin soft tissue thickness and Z angle. And SPSS 22.0 software was used to analyze the correlation between OP-P and other measurement indexes. The change of posterior occlusal plane was positively related to the distance from upper lip to the esthetic plane, the distance from lower lip to the esthetic plane, the tension of the upper lip and distance from lower lip to H line, and the change of posterior occlusal plane was negatively related to nasolabial angle and Z angle. The change of posterior occlusal plane had no significant correlation with upper lip base thickness and soft tissue chin thickness. The change of posterior occlusal plane has an important guiding significance for orthodontic treatment,by focusing on the change of the posterior occlusal plane to achieve the purpose of changing the soft tissue profile.

RESUMEN: Se realizó un estudio cefalométrico antes y después del tratamiento de ortodoncia en pacientes portadores de maloclusión clase II división 1 de Angle. Se observaron cambios en el perfil de los tejidos blandos y se exploró si había una correlación entre el cambio del plano oclusal posterior (OP-P) y el perfil de los tejidos blandos. El objetivo de este estudio fue otorgar una referencia teórica en el diagnóstico clínico y el tratamiento de ortodoncia de los pacientes con dentición permanente temprana con maloclusión clase II división 1 de Angle. Seleccionamos al azar 20 casos cefalometrías de pacientes de ortodoncia de la Universidad Médica de Shanxi (entre 12 y18 años). Para ello, se utilizó el software Winceph 8.0 para medir el plano oclusal posterior (OP-P), TUL-EP, TLL-EP, ángulo nasolabial, grosor de la base del labio superior, tensión del labio superior, distancia entre líneas del labio inferior H, grosor del tejido blando del mentón y ángulo Z. Se utilizó el software SPSS 22.0 para analizar la correlación entre OP-P y otros índices. El cambio del plano oclusal posterior tuvo una correlación positiva con la distancia desde el labio superior al plano estético, la distancia desde el labio inferior hasta el plano estético, la tensión del labio superior y distancia del labio inferior a la línea H. El cambio del plano oclusal posterior tuvo una correlación negativa con el ángulo nasolabial y el ángulo Z. El cambio del plano oclusal posterior no tuvo una correlación significativa con el grosor de la base del labio superior y la barbilla de tejido blando. El cambio del plano oclusal posterior tiene un importante significado de orientación para el tratamiento de ortodoncia, de tal manera que al cambiar el plano oclusal posterior se podrá lograr el propósito de cambiar el perfil del tejido blando.

Relación entre el plano oclusal y discrepancia posterior en pacientes con maloclusión clase II y III con ángulo alto y bajo / Relationship between the occlusal plane and posterior discrepancy in patients with class II and III malocclusion with high and low angle

Objetivos: Relacionar el plano oclusal con la discrepancia posterior aplicando el cefalograma de kim y el análisis del marco dental del Dr. Sato. Material y métodos: El presente estudio se efectuó en radiografías cefalometricas de 80 pacientes entre las edades de 15 a 25 años de ambos sexos, distribuidas en 4 grupos cuyo tamaño fue determinado por formula: 20 radiografías laterales de pacientes con maloclusión clase II ángulo bajo, 20 con ángulo alto, 20 radiografías de pacientes para maloclusión clase III ángulo bajo y 20 con ángulo alto. La técnica de recolección de datos fue la observación radiográfica, la cual se operatizo a través de su respectivo instrumento. El análisis de los datos se realizó mediante la estadística descriptiva e inferencial: X² y correlación Pearson, usando el paquete estadístico SPSS-21. Resultados: En las maloclusiones II ángulo bajo y alto, y en la clase III ángulo bajo mayormente no presentan discrepancia posterior; en la maloclusión clase III ángulo alto si presenta en su mayoría discrepancia posterior. Las maloclusiones clase II alto y bajo muestran un doble plano oclusal, mientras que las maloclusiones III alto y bajo mayormente presentan un solo plano oclusal. En las maloclusiones clase II con ángulo bajo existe relación directa entre la discrepancia posterior, el plano oclusal. Conclusiones: Con ángulo alto no hay relación en la discrepancia posterior y plano oclusal. En la maloclusión clase III con ángulo alto y bajo no se encontró relación estadísticamente significativa entre discrepancia posterior y plano oclusal. (AU)

Objectives: To relate the occlusal plane to the posterior discrepancy by applying the kim cephalogram and the analysis of the dental framework of Dr Sato. Material and methods: The present study was carried out on cephalometric radiographs of 80 patients between the ages of 15 and 25 years of age, divided into 4 groups whose size was determined by formula: 20 lateral radiographs of patients with malocclusion class II low angle, 20 with high angle, 20 xrays of patients for malocclusion class III low angle and 20 with high angle. The technique of data collection was radiographic observation, which was performed through its respective instrument. Data analysis was performed using descriptive and inferential statistics: X² and Pearson correlation, using the statistical package SPSS-21. Results: In the low and high angle II malocclusions, and in the low angle III class, there is no posterior discrepancy; In the class III malocclusion high angle if it presents in its majority later discrepancy. High and low class II malocclusions show a double occlusal plane, while the high and low III malocclusions mostly present a single occlusal plane. In class II malocclusions with low angle there is a direct relationship between the posterior discrepancy, the occlusal plane. With high angle there is no relation in the posterior discrepancy and occlusal plane. Conclusions: In the class III malocclusion with high and low angle there was no statistically significant relationship between posterior discrepancy and occlusal plane. (AU)

Tratamento ortodôntico mediante o controle do plano oclusal e da dimensão vertical com arcos gummetal / Orthodontic treatment through control of the occlusal plane and the vertical dimension with gummetal arches

O objetivo básico do tratamento de Ortodontia é restaurar a harmonia do esqueleto maxilo-facial através do controle da dimensão vertical e do plano oclusal. O método multi-bráquetes, amplamente usado na terapia ortodôntica, permite o controle tridimensional dos dentes. Durante muito tempo os ortodontistas não aproveitaram esse controle, concentrando-se apenas no movimento mesio-distal, uma vez que a principal técnica para alinhar e melhorar o perfil do paciente era movendo os caninos distalmente, permitindo em seguida a retração dos incisivos. Em 1967, Dr. Young Kim, em Boston, reconheceu a importância da verticalização do eixo dos dentes, do controle vertical e introduziu os "Multiloop Edgewise Arch Wire" (MEAW). Nos anos 80, Dr. Sadao Sato, no Japão, propôs novas ideias para esses arcos, usando-os para diferentes tipos de más oclusões, controlando a dimensão vertical e alterando a inclinação do plano oclusal com notável êxito. Apesar da eficiência biomecânica dos Arcos MEAW, eles demandam muito trabalho, pois são várias dobras complicadas e, para tanto, requerem uma formação específica da técnica. Outro inconveniente desses arcos é o seu volume na boca do paciente, o que dificulta a higiene e também é antiestético. Todos esses fatores têm dificultado a expansão da técnica MEAW, no entanto, foi encontrada uma maneira de mudar a reduzida constante elástica dos arcos MEAW, os quais são feitos com fio Elgilloy 0.16" x 0.22", utilizando um fio estruturado mais simples. Recentemente, foi introduzida no mercado uma nova liga chamada GUMMETAL. As características do GUMMETAL estão perfeitamente adequadas para superar todos os inconvenientes dos arcos MEAW, mencionados anteriormente.(AU)

The basic goal of orthodontic treatment is to restore the harmony of the maxillofacial skeleton by controlling the vertical dimension and the occlusal plane. The multi-bracket method, widely used in orthodontic therapy, allows three-dimensional control of teeth. For a long time, orthodontists did not take advantage of this control, concentrating only on the mesio-distal movement, since the main technique to align and improve the patient's profile was to move the canines distally, allowing the incisors to retract. In 1967, Dr. Young Kim, in Boston, recognized the importance of vertical axis of the teeth, the vertical control and introduced the Multiloop Edgewise Arch Wire (MEAW). In 1980, Dr. Sadao Sato, in Japan, proposed new ideas for these arches, using them for different types of malocclusions, controlling the vertical dimension and changing the inclination of occlusal plane with remarkable success. Despite the biomechanical efficiency of the MEAW arches, they require a lot of work, as they are several complicated folds and, for that, requires a specific technique training. Another drawback of these arches is the volume in the patient's mouth, which makes hygiene difficult and is also anti-aesthetic. All these factors have made it difficult to expand the MEAW technique, however, a way has been found to change the reduced elastic constant of the MEAW arches, which are made with Elgilloy .016x.022" wire, using a simpler structured wire. Recently, a new alloy called GUMMETAL was introduced in the market. The characteristics of GUMMETAL are perfectly suited to overcome all the drawbacks of the MEAW arches mentioned above.(AU)

Estudio del Plano Oclusal de una Población Chilena según los Cefalogramas de Steiner, Ricketts y Delaire / Study of the Occlusal Plane in a Chilean Population Using the Cephalometric Analysis of Steiner, Ricketts and Delaire

El propósito de esta investigación fue comparar la ubicación del Plano Oclusal (PO) en una población eugnásica chilena mediante el análisis cefalométrico de Steiner, Ricketts y Delaire. Estudio transversal. Se analizaron 96 telerradiografías digitales de adultos jóvenes chilenos eugnásicos (47 hombres y 49 mujeres) entre 18 y 35 años. En las telerradiografías de determinó la ubicación del PO de acuerdo a los parámetros cefalométricos de Ricketts, Steiner y Delaire. Todos los trazados cefalométricos fueron realizados utilizando el software Adobe® Photoshop® CC, versión 14.2.1. Para las mediciones angulares correspondientes a los análisis de Steiner y Ricketts se utilizó el software Screen Protractor version 4.0© 2006. Para las mediciones milimétricas correspondientes al análisis de Delaire, se utilizó el software Screen Calipers versión 4.0© 2006. Al aplicar el análisis de Steiner en la muestra se obtuvo un promedio de 17,16° para el ángulo formado entre el plano Silla-Nasion y el PO (norma 14,5±3°). Al utilizar el análisis de Ricketts, el ángulo promedio formado por el plano de Frankfurt y el PO fue 6,98° (norma 7,5±2°) Según el análisis de Delaire, la distancia en milímetros desde el PO al punto medio entre las cúspides vestibulares del primer y segundo premolar inferior fue 1,76 mm (referencia teórica 0±1 mm). El promedio de la angulación del PO se encuentra dentro del rango de normalidad según la norma de Steiner y Ricketts y el promedio de la distancia medida en milímetros del PO al punto medio entre las cúspides vestibulares del primer y segundo premolar inferior difiere en 1,76 mm de la referencia teórica del análisis cefalométrico de Delaire. Se recomienda realizar nuevos estudios que permitan definir las normas cefalométricas apropiadas para la poblacion chilena, lo que podría mejorar tanto diagnóstico como planes de tratamiento en diversas áreas de la odontología.

The aim of this study was to compare the location of the occlusal plane (OP) in a eugnathic Chilean population using Steiner, Ricketts, and Delaire cephalometric analysis. A cross-sectional study was carried out and ninety-six digital cephalometric radiographs from 47 male and 49 female young adults between ages 18 and 35 were analyzed to determine the location of the OP according to Steiner, Ricketts and Delaire cephalometric parameters. Cephalometric tracings were obtained with Adobe® Photoshop® CC, version 14.2.1 for all three analysis. Screen Calipers version 4.0© 2006 software was used to measure the distance in millimeters from the OP to a midpoint between the first and second inferior premolars cusps for Delaire analysis. For Steiner and Ricketts angle measurements, software Screen Protractor version 4.0© 2006 was used. Mean and Standard Deviation Tests for Steiner analysis showed that the mean angle between Sella-Nasion plane and OP was 17.16° (cephalometric norm 14.5±3°). The mean angle between Frankfurt plane and OP was 6.98° (cephalometric norm 7.5±2°) for Ricketts analysis. In Delaire analysis, the distance in millimeters from the OP to a midpoint between the first and second inferior premolars cusps obtained was 1.76 mm, which differs from the theoretical reference (0±1 mm). The mean angle of the occlusal plane obtained is within the average standards for Steiner and Ricketts analysis. The mean distance in millimeters obtained from the OP to a midpoint between the first and second inferior premolars cusps in this study differs from the theoretical reference reported in Delaire analysis. Further studies are recommended to study more appropriate cephalometric norms for the Chilean population that would improve diagnosis and treatment plans in different areas of the dentistry field.

Paralelismo entre plano oclusal y plano de Camper / Parallelism between the occlusal plane and the Camper's line

Objetivo: El propósito de este estudio fue verificar la relación de paralelismo entre el plano oclusal y 3 definiciones de plano de Camper en una población eugnásica chilena. Material y métodos Estudio transversal. Se seleccionaron 60 adultos jóvenes chilenos eugnásicos (32 hombres y 28 mujeres) entre 18 y 35 años. Se utilizaron telerradiografías de perfil digitales y fotografías faciales laterales estandarizadas. Se superpuso la cefalometría en las fotografías laterales con el programa Quick-Ceph®. Los planos de Camper se trazaron desde 3 diferentes puntos de inicio en el tragus (superior, medio e inferior) hacia el punto más inferior del ala de la nariz. Se midieron los ángulos formados entre el plano oclusal y los 3 planos de Camper resultantes con el programa Screen Protractor®. Resultados El análisis ANOVA muestra diferencias significativas entre los 3 ángulos. El ángulo promedio entre el plano de Camper medio y el plano oclusal fue -0,63°. En hombres, el plano de Camper medio fue más paralelo al plano oclusal (1,11°) y en mujeres el plano de Camper superior fue el más paralelo con el plano oclusal (1,39°). Conclusión El paralelismo fue verificado para el plano de Camper medio en hombres y para el plano de Camper superior en mujeres.

Objective: The aim of this study was to verify the parallelism between the occlusal plane and three different Camper's line definitions in a Chilean eugnathic population. Material and methods Cross-sectional study was conducted on 60 Chilean eugnathic young adults (32 males and 28 females) between 18 and 35 years old. Lateral digital standardised cephalometric radiographs and facial photographs were used. The cephalometric analysis was superimposed over the lateral photographs with Quick-Ceph® software. The Camper's line was traced from three different starting points at the Tragus (upper, middle and lower) to the lowest point below the nostrils. The angles obtained between the occlusal plane and the resulting Camper's lines were measured with Screen Protractor® software. Results The ANOVA test showed significant differences for the obtained angles. The mean parallelism between the medium Camper's line and the occlusal plane was -0.63°. In males, the medium Camper's line was more parallel to the occlusal plane (1.11°), and for females, the upper Camper's line was the most parallel to the occlusal plane (1.39°). Conclusion The parallelism was verified for the medium Camper's line in males, and for the upper Camper's line in females.

El arco facial en la elaboración de las férulas oclusales tipo Míchigan / Face bows in the production of Michigan occlusal splints

Introducción: la férula oclusal tipo Míchigan (FOM) es un dispositivo usado frecuentemente para el manejo de pacientes con bruxismo. La literatura menciona el uso del arco facial para el montaje de modelos en el articulador semiajustable, sin embargo el beneficio de este en la elaboración de las FOM aún es controvertido. Por lo tanto el objetivo de esta investigación fue comparar el registro de número de puntos de contacto y el tiempo de ajuste entre las FOM elaboradas con y sin el uso del arco facial en pacientes con diagnóstico de bruxismo. Métodos: se elaboraron 90 férulas entregadas a 45 pacientes de la Clínica de Rehabilitación Benemérita Universidad Autónoma de Puebla (BUAP), previo diagnóstico de bruxismo. Las dos férulas elaboradas (una con modelos montados con arco facial y otra sin él), se compararon en el articulador y clínicamente. Se registró el número de puntos de contacto obtenidos en ambas férulas y el tiempo de ajuste requerido. Las comparaciones se hicieron con la prueba estadística de Wilcoxon y significancia menor a 0,05. Resultados: la media de puntos de contacto en boca de las férulas con el uso del arco fue superior (11,67) a la de sin uso del arco (11,58) sin diferencias significativas (p = 0,799). El tiempo de ajuste fue superior en las férulas elaboradas sin arco (51 s) que con arco (33 s), sin diferencias significativas (p = 0,332). Conclusión: no existen diferencias significativas con el uso del arco facial o sin él para la elaboración de las FOM en pacientes bruxómanos.

Introduction: Michigan occlusal splints (MOS) are frequently used for the management of patients with bruxism. The literature mentions the use of face bows for mounting models in semi-adjustable articulators, but its benefit in the production of MOS is still controversial. Therefore, the objective of this study was to compare the record of number of contact points and mounting time between MOS made with and without face bows in patients diagnosed with bruxism. Methods: a total of 90 splints were made and distributed among 45 patients diagnosed with bruxism at the Oral Rehabilitation Clinic of Benemérita Universidad Autónoma de Puebla (BUAP). The two splints (one made with a face bow mounted model and the other one without it) were compared at the articulator and clinically. The number of obtained contact points was recorded in both splints as well as the time needed for mounting. The comparisons were made with Wilcoxon statistical test and a significance level lower than 0.05. Results: the splints with face bows showed a greater average of contact points in the mouth (11.67) compared with the ones without face bows (11.58), with no significant difference (p = 0.799). Mounting time was higher in the splints made without face bows (51 s) compared with the ones with face bows (33 s), with no significant difference (p = 0.332). Conclusion: there are no significant differences in using face bows for developing MOS in bruxism patients.

Visualización del plano oclusal y guía anterior en desdentados parciales en la telerradiografía lateral: descripción de la técnica a través de casos clínicos / Occlusal plane and anterior guidance visualization in lateral cephalometric radiographs in partially edentulous patients: technique description through case reports

El uso de la telerradiografía lateral ha tomado gran importancia en Rehabilitación Oral ayudando al clínico en el diagnóstico y planificación del tratamiento a través de la identificación del biotipo facial del paciente, la inclinación del plano oclusal, la relación anteroposterior entre maxilar y mandíbula, inclinación de los ejes dentarios y como ayuda complementaria en casos de alteraciones de la Dimensión Vertical. El problema surge cuando estamos frente a pacientes desdentados que han perdido puntos de referencia cefalométricos necesarios para el análisis. El presente trabajo muestra una técnica para poder visualizar radiográficamente el plano oclusal y la guía anterior utilizando láminas de plomo.

The use of lateral cephalometric radiographs has become very important in Oral Rehabilitation, helping the clinician in the diagnosis and treatment planning through the identification of facial biotype, occlusal plane inclination, sagittal relationship between maxilla and mandible, inclination of the dental axes, and a valuable help in assessing alterations of the vertical dimension of occlusion. The problem arises when treating partially edentulous patients who have lost their cephalometric reference points necessary for the analysis. This paper shows a technique to visualize the occlusal plane and anterior guidance in partially edentulous patients who have lost these anatomical landmarks in a lateral cephalometric radiograph, using lead sheets.

Inclinación del plano oclusal en niños entre nueve y diez años de edad con asimetría postural: estudio en el plano frontal / Occlusal plane inclination in children between 9 and 10 years old with postural asymmetry: study on the frontal plane

Introducción: con el fin de establecer la relación entre el lado y sentido de la inclinación del plano oclusal en niños con asimetría postural de la unidad supraescapular, se hizo un estudio observacional en 34 sujetos de nueve y diez años de edad. Métodos: la asimetría postural y la inclinación del plano oclusal utilizando una platina de fox fueron medidas a través de un análisis fotográfico estandarizado por el software Kinovea 0.7.10 versión 2. Resultados: 18 sujetos de la muestra presentaron ángulo cervical medio occipital-cintura escapular menor (ACMOCEM) a la izquierda con un ángulo mínimo de 87,4°; 4 de ellos mostraron plano oclusal elevado (POE) en el mismo lado, con respecto al plano bipupilar; 11 de ellos lo mostraron elevado a la derecha y 3 de ellos no presentaron inclinación del plano oclusal. 16 sujetos de la muestra presentaron un ACMOCEM a la derecha con ángulo mínimo de 87,13°; 5 de ellos mostraron POE al mismo lado, 7 lo mostraron elevado a la izquierda y 4 no presentaron inclinación del plano oclusal. Los estadígrafos utilizados fueron media y desviación estándar. Conclusión: se concluyó que en niños sanos con asimetría postural existe tendencia a mostrar un plano oclusal más bajo del lado de la inclinación de cabeza supuestamente debido a factores de crecimiento dentoalveolar.

Introduction: with the purpose of establishing the relationship between side and direction of occlusal plane inclination in children with postural asymmetry of the suprascapular unit, an observational study was conducted in 34 subjects aged 9 to 10 years.Methods: both postural asymmetry and occlusal plane inclination using a fox plate were measured by means of photograph analysis standardized with the Kinovea 0.7.10 software version 2. Results: 18 subjects presented a minor occipital middle cervical-scapular waist angle (MOMCSWA) to the left, with a minimum angle of 87.4º; 4 of them presented elevated occlusal plane (EOP) in the same side in relation the bipupillary plane; in 11 patients this plane was elevated to the right, and 3 did not present occlusal plane inclination. 16 of the subjects presented (MOMCSWA) to the right with a minimum angle of 87.13º; 5 of them showed EOP to the same side, in 7 patients the plane was elevated to the left, and 4 did not present occlusal plane inclination. The variables used were average and standard deviation. Conclusion: this study allowed concluding that healthy kids with postural asymmetry present a tendency to have a lower occlusal plane to the side of head inclination, probably due to factors related do dentoalveolar growth.

Changes in occlusal plane through orthognathic surgery / Alteração do plano oclusal na cirurgia ortognática

INTRODUCTION: A conventional ortho-surgical treatment, although with good clinical results, does not often achieve the desired functional outcomes. Patients with dentofacial deformities, especially those with increased occlusal planes (OP), are also affected by muscle, joint and breathing functional disorders, as well as facial esthetic involvement. The surgical manipulation of the OP in orthognathic surgery is an alternative to overcome the limitations of conventional treatment. OBJECTIVE: To report the importance of assessing the occlusal plane during diagnosis, planning and ortho-surgical treatment of patients with facial skeletal deformities and its main advantages. CONCLUSION: Although both philosophies of ortho-surgical treatment (conventional and by surgical manipulation of the OP) have presented good results, the selective correction of the OP allows a full treatment of these patients, providing better esthetic and functional results.

INTRODUÇÃO: o tratamento ortocirúrgico convencional, embora apresente bons resultados clínicos, muitas vezes não alcança resultados funcionais desejáveis. Os pacientes com deformidades dentofaciais, principalmente os que possuem plano oclusal (PO) aumentado, são acometidos também por distúrbios funcionais musculares, articulares e respiratórios, além do comprometimento estético facial. A manipulação cirúrgica do PO na cirurgia ortognáticaé uma alternativa para suprir as limitações do tratamento convencional. OBJETIVO: relatar a importância da avaliação do plano oclusal nas fases de diagnóstico, planejamento e tratamento ortocirúrgico de pacientes com deformidades esqueléticas faciais, e suas principais vantagens. CONCLUSÃO: apesar de ambas as filosofias de tratamento ortocirúrgico (convencional e pela manipulação cirúrgica do PO) apresentarem bons resultados, a correção seletiva do PO permite um tratamento integral desses pacientes, propiciando melhores resultados estéticos e funcionais.

Caracterización del plano oclusal y diferentes marcos dentoesqueléticos en escolares entre 5 y 6 años / Characterization of the occlusal plane and dentoskeletal types inschool children between 5 and 6 years

Introduction and objectiveUnderstanding the anatomical and physiological modulation of the occlusal plane during growth is criticalin identifying some of the factors contributing to the establishment of malocclusion.To characterize the occlusal plane and the development of different dentoskeletal types in school childrenbetween 5 and 6 years.Materials and MethodsThis descriptive study considered a convenience sample of 107 schoolchildren who met the inclusioncriteria. The analyzed variables were Dental Framework, Kim, occlusal plane and FH plane, determined byusing anatomic and orbital positions, which served as reference points. Occlusal planes were determinedby considering deciduous and mixed dentition, respectively.ResultsThe classification of the occlusal plane identified in showed that in 65,7% of the school children there wasa stable occlusal plane, in 22,9% inclined and in 11,4% flat. In Class III, no data were found with respectto the inclined plane. All patients were between a stable and a flat occlusal plane. A greater proportionwas that of the angle of the acute maxillary plane. In the multivariate analysis identified a possible (11,5%) was found consistent of males with a Class II skeletal pattern, no occlusal plane angulation and obtuseangulation of the maxillary plane.ConclusionThere is a tendency for Class I children to have a stable occlusal plane, Class II individuals an inclinedocclusal plane, and Class III children a flat occlusal plane.

Introduction and objectiveUnderstanding the anatomical and physiological modulation of the occlusal plane during growth is criticalin identifying some of the factors contributing to the establishment of malocclusion.To characterize the occlusal plane and the development of different dentoskeletal types in school childrenbetween 5 and 6 years.Materials and MethodsThis descriptive study considered a convenience sample of 107 schoolchildren who met the inclusioncriteria. The analyzed variables were Dental Framework, Kim, occlusal plane and FH plane, determined byusing anatomic and orbital positions, which served as reference points. Occlusal planes were determinedby considering deciduous and mixed dentition, respectively.ResultsThe classification of the occlusal plane identified in showed that in 65,7% of the school children there wasa stable occlusal plane, in 22,9% inclined and in 11,4% flat. In Class III, no data were found with respectto the inclined plane. All patients were between a stable and a flat occlusal plane. A greater proportionwas that of the angle of the acute maxillary plane. In the multivariate analysis identified a possible (11,5%) was found consistent of males with a Class II skeletal pattern, no occlusal plane angulation and obtuseangulation of the maxillary plane.ConclusionThere is a tendency for Class I children to have a stable occlusal plane, Class II individuals an inclinedocclusal plane, and Class III children a flat occlusal plane.

Avaliação da alteração do plano oclusal em pacientes dolicofaciais portadores de classe II mandibular que utilizaram o aparelho Bionator de Balters / Evaluation of occlusal plane changes in dolichofacial patients with mandibular class II malocclusion after Balters Bionator therapy

Objetivo: avaliar cefalometricamente a influência do Bionatorde Balters no plano oclusal em pacientes dolicofaciais portadoresde maloclusão de Classe II de Angle associadas ao retrognatismomandibular, durante a fase de crescimento. Metodologia:a amostra consistiu de 40 telerradiografias obtidas em doistempos (T1: inicial; T2: após bionatorterapia) de 20 pacientes,sendo 10 do sexo masculino e 10 do sexo feminino com idadesvariando entre 7 e 15 anos (média de 9,03). Resultados e Conclusões:constatou-se um controle bastante eficiente da inclinaçãodo plano oclusal, provocando sua rotação anti-horária, o que éconsiderado essencial na estabilidade dos resultados.

Aim: the purpose of this study is a cephalometric evaluationof the influence of the Balters Bionator on the occlusal plane indolichofacial patients with mandibular Class II malocclusionduring growth period. Methods: the sample comprised of 40 lateralcephalograms taken at two times (T1: initial; T2: after bionatortherapy)from 20 patients, 10 females and 10 males withage ranging between 7 and 15 years (average 9,03). Results andconclusions: an efficient control of the occlusal plane inclinationwas evidenced resulting counter clockwise rotation which wasessential for the achievement and stability of the results.

Características craneofaciales en pacientes con desgaste dentario severo / Craniofacial characteristics in patients with severe toothwear

Introducción: con la finalidad de contrastar la hipótesis nula “no existen diferencias significativas en lascaracterísticas arquitecturales y estructurales craneofaciales entre individuos con y sin desgaste dentario” se realizó un estudio analítico, no experimental de casos y controles en pacientes que consultaron por tratamiento prostodóncico u ortodóncico. Métodos: la muestra quedó conformada por 26 pacientes con desgate dentario severo (estudio) y 52 pacientes sin desgaste dentario (control).El grupo control se obtuvo por pareamiento según sexo, rango de edad y ángulo de la base de cráneo. Todos ellos poseían estabilidad oclusal y no presentaban tratamiento ortodóncico previo, procedimientos quirúrgicos maxilofaciales ni patologías de crecimiento y desarrollo. Se utilizó un cefalograma específicamente diseñado que incluyó los parámetros arquitecturales y estructurales delanálisis de Delaire. Para el análisis de los datos fueron utilizados el t Test y el Chi cuadrado dependiendo de la naturaleza de los datos. Resultados: diferencias significativas fueron encontradas particularmente a nivel del hueso basal maxilar y mandibular y en la posición del plano oclusal real respecto al plano oclusal teórico. Conclusiones: se concluyó que en pacientes con desgaste dentario severo, se produce una modificación del hueso basal y mandibular por remodelación del proceso dentoalveolar que resulta en una rotación craneal del plano oclusal. Se observa aparente estabilidad de la altura facial y del ángulo mandibular a pesar del cambio obvio de la posición del plano oclusal.

Introduction: in order to test the null hypothesis “there are no significant differences in the craniofacial architectural and structural characteristics among individuals with and without severe tooth wear”, a non experimental analytic case controlstudy was carried out with patients who consulted for prosthodontic or orthodontic treatment. Methods: 78 patients between 22 and 55 years of age participated. The experimental group consisted of 26 patients between 29 and 55 years of age (9 women and17 men). The control group consisted of 52 patients between 22 and 50 years of age (18 women and 34 men) matched by gender —age range and posterior cranium base angle. All of them had occlusal stability, without previous orthodontic treatment, surgeryor growth and development alterations. The measuring instrument was a specifically designed cephalogram which included the architectural and structural parameters from Delaire’s Analysis, combined with some extra radiographic points defined by the authors for this particular study. The parameters under investigation were different cranial structural relationships includingocclusal plane position. Statistical analysis using t-test, Chi square test and Pearson’s correlation test were carried out depending of the nature of the data. Results: significant differences were particularly found on maxillary and mandibular basal bone and on the position of the actual occlusal plane with respect to the theoretical plane. Conclusions: it was concluded that in patients with severe tooth wear, a modification of the maxillary and mandibular basal bone could have taken place with remodelling of the dental alveolar process resulting in a cranial rotation of the occlusal plane. An apparent stability of the facial height and the mandibular angle was observed in spite of the obvious change in the position of the occlusal plane.

Manipulación del plano oclusal en cirugía ortognática: consideraciones faciales / Manipulation of the oclusal plane in orthognathic surgery: facial considerations

El plano oclusal ha sido un elemento importante en cirugía ortognática durante los últimos 20 años. Las investigaciones iniciales demostraron que las características faciales están altamente asociadas a la posición mandibular; siendo así, la rotación del plano oclusal permite una reposición oclusal diferente de la inicial, además una relación facial tanto vertical como anteroposterior favorable en términos de estética y proporciones faciales. Las investigaciones realizadas para cuantificar y caracterizar este movimiento han sido limitadas, pero auspiciosas; se ha determinado que la rotación del plano oclusal es un movimiento estable y versátil, siendo útil en diferente tipos de pacientes. El objetivo de este estudio es identificar las principales características asociadas a la rotación del plano oclusal así como analizar las principales investigaciones al respecto.

Occlusal plane has been an important element in orthognatic surgery during these last 20 years. The primary investigations have shown that facial characteristics are highly associated to mandibular positioning. Thus, occlusal plane rotation allows an acclusal plan different from the initial one, even as vertical and anterior-posterior positioning more favorable en endings of aesthetic. Besides the studies carried through to measure y to characterize these movements are limited, they are favorable. They have demonstrated that occlusal plane rotation versatile y stable, being useful en different types of facial deformities. The meaning of this work are identify the more important characteristic about occlusal plane rotation as well analyze the most cited articles in the literature.

Biomethrics study of the retromolar pad / Estudio biométrico de la papila retromolar

The retromolar pad is a mucosal formation that is used for determining the height of the occlusal plane. The present study analyzes the biometric characteristics of 81 retromolars pad, maximum longitudinal and transverse diameters were measured and classified according to shape. The maximum transverse diameter present an average of 7.94 mm (SD 2.09), while the maximum longitudinal diameter average was 11.202 mm (SD 2.5089), there were no significant differences between the average obtained on the right and left side retromolar pad (p<0.05). The 53.1 percent was classified as oval (N = 43), 29.6 percent rounded (N = 24) and 17.3 percent as triangular (N = 14).

La papila retromolar es una formaciónmucosa que se utiliza para la determinación de la altura del plano oclusal. En el presente estudio se analizan las características biométricas de 81 papilas retromolares, se midieron los diámetros transverso y longitudinal máximo y se clasificaron de acuerdo a forma. El diámetro transverso máximo presentó una media de 7,94 mm (DS 2,09), mientras que la media del diámetro longitudinal máximo fue de 11,202 mm (DS 2,5089), no se encontraron diferencias significativasentre las medias obtenidas en la papila retromolar del lado derecho e izquierdo (p<0,05). El 53,1 por ciento fue clasificada como ovalada (N=43), el 29,6 por ciento como redondeada (N=24) y el 17,3 por ciento como triangular (N=14).

Avaliação das alterações do plano oclusal em telerradiografias em norma lateral no tratamento de más oclusões de Classe II, 1ª divisão, com Bionator de Balters, em pacientes retrovertidos, neutrovertidos e provertidos / Evaluation of occlusal plane changes in retroverted, neutroverted and proverted patients, with Class II, division 1, malocclusion treated with Balters' Bionator

OBJETIVO: este trabalho objetiva verificar as alterações do plano oclusal funcional de Ricketts, utilizando as variáveis que orientam este plano nas análises cefalométricas de Ricketts e Schawrz-Faltin, em pacientes portadores de má oclusão de Classe II de Angle, 1ª divisão, associada ao retrognatismo mandibular, cuja terapêutica indicada tenha sido a Bionatorterapia. METODOLOGIA: a amostra coletada neste estudo retrospectivo consta de 128 telerradiografias em norma lateral de 64 indivíduos retrovertidos, neutrovertidos e provertidos, de ambos os gêneros, no estágio de desenvolvimento da oclusão em fase mista ou permanente jovem. A faixa etária dos indivíduos selecionados para o estudo variou entre 7 anos e 1 mês a 13 anos e 2 meses no momento T1, sendo a média inicial de 10 anos de idade. A média de duração do tratamento foi de 19,7 meses. RESULTADOS E CONCLUSÃO: os resultados mostraram comportamentos distintos do plano oclusal, conforme o tipo facial retrovertido, neutrovertido ou provertido. O controle do plano oclusal na Bionatorterapia, pelo manejo do Bionator conforme o tipo facial de cada paciente, por meio de desgastes seletivos no acrílico e conseqüente erupção diferenciada dos dentes, pode influenciar favoravelmente o crescimento geral da face em cada tipo facial.

AIM: This work aims to verify the changes of Ricketts functional occlusal plane making use of variables which guide this same plane in the cephalometric analysis of Ricketts and Schwarz-Faltin among patients with Class II, division 1 malocclusion, associated to mandible retrognathism, whose therapy indicated has been Bionatortherapy. METHODS: The sample collected in this retrospective survey has 128 lateral cephalograms of 64 retroverted, neutroverted and proverted individuals, of both genders, at the stage of developing occlusion, either in mixed phase or permanent young. The age scale of individuals selected by the survey goes from 7 years and 1 month up to 13 years and 2 months in the T1 moment, with an initial mean age of 10 years. The mean length of time of treatment has been of 19.7 months. RESULTS AND COONCLUSION: The overall results have been submitted to statistical analysis and have shown that in the group of retroverted patients the occlusal plane goes round clockwise, in the group of neutroverted ones, the occlusal plane did not show up any relevant alterations between moments T1 and T2, and in the group of proverted patients the occlusal plane goes round counterclockwise. The occlusal plane control in the Bionatortherapy through the handle of the Bionator according to the facial type of each patient, through selective worn out acrylic and consequent diversified eruption of the teeth, can indeed cause favorable influence towards the overall growing up of the face in every facial type.