Reabilitação oral com próteses parciais removíveis após restabelecimento de dimensão vertical de oclusão e tratamento multidisciplinar: relato de caso / Oral rehabilitation with removable partial dentures after restoration of the vertical dimension of occlusion and multidisciplinary treatment: case report

As próteses parciais removíveis (PPRs) são uma alternativa de tratamento viável na prática clínica para reabilitar arcos parcialmente desdentados. Entretanto, o planejamento dessas próteses e preparo bucal prévio são frequentemente negligenciados. O presente artigo tem como objetivo relatar o caso clínico de uma reabilitação oral com PPRs superior e inferior após abordagem multidisciplinar, de modo a enfatizar as fases de um planejamento criterioso e de preparo prévio dos dentes pilares, visando o sucesso e a longevidade da reabilitação. Paciente do sexo masculino de 57 anos de idade compareceu à clínica da Faculdade de Odontologia de Bauru, Universidade de São Paulo, queixando-se da estética de seu sorriso e de algumas ausências dentárias. O indivíduo utilizava uma PPR provisória inferior insatisfatória e apresentava perda de dimensão vertical de oclusão (DVO). Após o exame clínico, radiográfico e estudo do caso em articulador semi-ajustável, realizou-se o planejamento com abordagens restauradoras, endodônticas, periodontais e protéticas. Após tratamento periodontal, foi realizada endodontia dos elementos 12, 15 e 47, confecção de núcleos e coroas nos dentes 12 e 15, restauração a nível gengival para apoio residual no dente 47, restaurações nos dentes 11, 13, 22, 24 e 44 e, por fim, a confecção das PPRs superior e inferior. A abordagem multidisciplinar utilizada neste caso clínico viabilizou o restabelecimento da DVO e possibilitou o sucesso da reabilitação protética(AU)

Removable partial dentures (RPDs) are a viable treatment alternative in clinical practice to rehabilitate partially edentulous arches. However, the planning of these dentures and prior oral preparation are often neglected. This article aims to report the clinical case of an oral rehabilitation with upper and lower RPDs after a multidisciplinary approach, to emphasize the phases of careful planning and prior preparation of the abutment teeth, aiming at the success and longevity of the rehabilitation. A 57-year-old male patient came to the clinic of the Bauru School of Dentistry, University of São Paulo, complaining about the esthetics of his smile and some missing teeth. The subject was using an unsatisfactory lower provisional prosthesis and had a loss of vertical dimension of occlusion (OVD). After the clinical and radiographic examination and the case study in a semi-adjustable articulator, planning was carried out with restorative, endodontic, periodontal and prosthetic approaches. After periodontal treatment, endodontics were performed on elements 12, 15 and 47, creation of cores and crowns on teeth 12 and 15, restoration at the gingival level for residual support on tooth 47, restorations on teeth 11, 13, 22, 24 and 44 and, finally, the making of the upper and lower PPRs. The multidisciplinary approach used in this clinical case enabled the restoration of the OVD and enabled the success of the oral rehabilitation(AU)

Envelhecimento bucal precoce e suas consequências para a cavidade oral com foco em reabilitação com resina composta: relato de caso / Early oral aging and its consequences for the oral cavity focusing on rehabilitation with composite resin: case report

O envelhecimento bucal precoce apresenta cada vez uma maior incidência nos consultórios odontológicos e sua degradação aos tecidos orais exige uma atenção por parte do cirurgiãodentista devido ao seu alto grau de complexidade. Esse envelhecimento precoce é causado principalmente por hábitos parafuncionais, dieta ou ambos. Suas consequências são desgastes patológicos dos tecidos dentários, extrusão passiva, perda de dimensão vertical e comprometimento estético e funcional. Por conta disso, o presente estudo teve como objetivo realizar um relato de caso clínico em um paciente jovem e com queixa estética como consequência de hábitos parafuncionais, aonde foram realizados uma reabilitação oral envolvendo aumento da dimensão vertical de oclusão através de Table Tops sem desgastes dentários e restaurações estéticas, ambas com resina composta. Essa reabilitação devolveu a DVO da paciente, trazendo conforto, contatos estáveis, guias de desoclusão e satisfação estética e funcional por parte da paciente(AU)

Early oral aging has an increasing incidence in dental offices and its degradation to oral tissues requires attention from the dentist due to its high degree of complexity. This premature aging is mainly caused by parafunctional habits, diet, or both. Its consequences are pathological wear of dental tissues, passive extrusion, loss of vertical dimension and aesthetic and functional impairment. Because of this, the present study aims to carry out a clinical case report in a young patient with an aesthetic complaint as a result of parafunctional habits, where an oral rehabilitation was carried out involving an increase in the vertical dimension of occlusion through Table Tops without dental wear and aesthetic restorations, both with composite resin. This rehabilitation returned the patient's OVD, bringing comfort, stable contacts, disocclusion guides and aesthetic and functional satisfaction on the part of the patient(AU)

A comparative study of conventional and Hall techniques of crown placement using finite element stress analysis

Background: Hall technique of crown placement causes the changes in vertical occlusal dimension; the mode of settlement of which needs to be explored. Aim: To assess and compare the changing patterns of stress distribution following placement of stainless steel crowns on primary teeth by Hall and conventional techniques using a finite element model analysis. Materials and Methods: The clinical crown heights of primary molars restored with Hall and conventional techniques and opposing teeth in contact, vertical dimension changes in the primary canine area were measured using intraoral digital scan. T-scan was used to measure the changes in bite force while the finite element analysis was used to assess deformative changes on the 2nd, 5th, 10th, and 15th days. Results: The Hall technique of crown placement caused more stress distribution in the tooth supporting tissues that settled in 2 weeks as compared with conventional technique of crown placement in which settlement occurred in 2 days. Conclusion: The settling of vertical occlusal dimension as well as stress distribution in Hall technique probably takes place by intrusion of crowned tooth and opposing teeth in contact.

Correlation between vertical dimension of occlusion and different facial measurements among a sample of sudanese adults / Correlación entre la dimensión vertical de la oclusión y diferentes medidas faciales en una muestra de adultos sudaneses

Aim: This study aimed to evaluate the correlation between vertical dimension of occlusion (VDO) and various facial measurements in a sample of Sudanese adults. Material and Methods: A total of 113 dental students (33 males and 80 females) with a mean age of 21.7±1.26 years were enrolled in this study. Different facial measurements including (Eye-Mouth, Eye-Eye, Eye-Ear, and Ear Height) were compared with two different measurements of VDO: N-Gn (from the tip of the nose to the tip of the chin), and Sn-Me (from the base of the nose to the bottom of the chin). Pearson's correlation coefficient test was utilized for the correlation between the measured parameters. A p-value of less than 0.05 was considered significant for all analyses. Results: A significant positive correlation was shown between all measured facial distances and both measured VDO distances. Though, the strongest correlation was seen for the eye-mouth distance (r= 0.725, p<0.001), while the weakest was for ear height (r= 0.254, p= 0.007). A paired t-test revealed a significant longer N-Gn distance than Sn-Me distance. Also, it has been shown that there were no significant differences between right and left sides of the face. Conclusion: The distance measured from the outer canthus of the eye to the angle of the mouth can be used to predict Subnasale-Menton (Sn-Me) distance.

Objetivo: Este estudio tuvo como objetivo evaluar la correlación entre dimensión vertical oclusal (DVO) y varias medidas faciales en una muestra de adultos sudaneses. Material y Métodos: Un total de 113 estudiantes de odontología (33 hombres y 80 mujeres) con una edad media de 21,7 ± 1,26 años se inscribieron en este estudio. Se compararon diferentes medidas faciales que incluyen (ojo- boca, ojo-ojo, ojo-oído y altura de la oreja) con dos medidas diferentes de DVO: N-Gn (desde la punta de la nariz hasta la punta del mentón) y Sn -Yo (desde la base de la nariz hasta la parte inferior del mentón). Se utilizó la prueba del coeficiente de correlación de Pearson para la correlación entre los parámetros medidos. Un valor de p inferior a 0,05 se consideró significativo para todos los análisis. Resultados: Se mostró una correlación positiva significativa entre todas las distancias faciales medidas y ambas distancias DVO medidas. Sin embargo, la correlación más fuerte se observó para la distancia ojo-boca (r=0,725, p<0,001), mientras que la más débil fue para la altura de las orejas (r=0,254, p=0,007). Una prueba de t pareada reveló una distancia N-Gn significativamente más larga que la distancia subnasal-mentón. Además, se ha demostrado que no hubo diferencias significativas entre los lados derecho e izquierdo de la cara. Conclusión: La distancia medida desde el canto externo del ojo hasta el ángulo de la boca puede utilizarse para predecir la distancia subnasal-mentón.

Dimensión vertical de la cara en adultos con diferentes relaciones oclusales / Vertical dimension of face in adults with different Angle class

RESUMEN: Se ha postulado que la posición postural mandibular (PPM) no presentaría la menor actividad electromiográfica (EMG) de los músculos masetero y temporal, y que esta menor actividad se encontraría en una apertura mayor. El objetivo de este estudio fue analizar la PPM en pacientes con diferentes relaciones oclusales y según tipo de método de posicionamiento, relacionándolo con la actividad EMG de los músculos Masetero y Temporal, además del registro de la actividad EMG en diferentes aperturas orales. Se analizó una muestra de 25 adultos de 18 a 28 años. Estos fueron clasificados según su sexo y clasificación de Angle. Se realizaron simultáneamente registros de EMG de superficie -masetero y porción anterior del temporal- y de EMA -posición de la mandíbula respecto al maxilar obteniendo distancia y ángulo- en diferentes posiciones mandibulares: PPM-considerando método sin comando y de deglución- y apertura gradual hasta alcanzar la máxima apertura. Se realizó un análisis estadístico descriptivo. La menor PPM obtenida fue de 1,0 ± 0,6 mm en mujeres Clase III y utilizando la técnica sin comando; el mayor fue de 2,5 ± 0,2 mm en mujeres Clase II y utilizando la técnica de deglución. La apertura angular presentó menor variabilidad que las distancias lineales. La actividad de los músculos Maseteros derecho e izquierdo presentaron valores similares entre sí, al igual que en los rangos de apertura hasta 30 mm en hombres y mujeres y en las diferentes relaciones oclusales. La actividad de los Temporales para hombres y mujeres y en las diferentes relaciones oclusales mostraron variaciones importantes entre derecha e izquierda y en los diferentes grados de apertura. La técnica presentada permitió el estudio de la dimensión vertical y aperturas orales a través de EMA y EMG.

SUMMARY: It has been postulated that the mandibular postural position (MPP) could not present the lower electromyographic activity (EMG) of the Masseter and Temporal muscles, and that the lower activity could be found in a larger opening. The objective of this study was to analyze the PPM in patients with different occlusal relationships and according to the positioning method, relating it to the EMG activity of the Masseter and Temporal muscles, in addition to recording the EMG activity in different oral openings. A sample of 25 adults aged 18 to 28 years was analyzed. Participants were classified according to their sex and Angle classification. Simultaneous recordings of surface EMG -Masseter and anterior portion of the Temporal- and EMA -position of the Mandible with respect to the Maxilla obtaining distance and angle- were performed in different mandibular positions: PPM-considering the method "without command" and "swallowing"- and gradual opening until the maximum opening is reached. A descriptive statistical analysis was performed. The lowest PPM obtained was 1.0 ± 0.6 mm in Class III women and using the "without command" method; the largest was 2.5 ± 0.2 mm in Class II women and using the "swallowing" method. The angular opening presented less variability than the linear distances. The activity of the right and left masseter muscles presented similar values, as well as in the opening ranges up to 30 mm in men and women and in the different occlusal relationships. The activity of the Temporals for men and women and in the different occlusal relationships showed important variations between right and left and in the different degrees of opening. The presented technique allowed the study of the vertical dimension and oral openings through EMA and EMG.

Efeitos de customizações da prótese total mandibular sobre a qualidade de vida, força de mordida e eletromiografia de músculos da mastigação de pacientes edêntulos: um estudo clínico analítico intervencional / Effects of mandibular complete denture customizations on quality of life, bite force, and masticatory muscle electromyography in edentulous patients: an interventional analytical clinical study

Objetivo: Avaliar se customizações da prótese total mandibular (reembasamento e restabelecimento da dimensão vertical de oclusão) influenciam na amplitude eletromiográfica dos músculos masseter e temporal, força máxima de mordida e qualidade de vida relacionada à saúde oral de indivíduos edêntulos. Materiais e métodos: Usuários de próteses totais que usavam o mesmo par de próteses por mais do que 5 anos foram incluídos (sem disfunção temporomandibular) (n=15). Avaliações de qualidade de vida (Oral Health Impact Profile for Edentulous ­ OHIP-EDENT), força máxima de mordida, e eletromiografia dos músculos masseter e temporal foram realizadas em 5 tempos diferentes (T1 ­ próteses antigas originais; T2 ­ após 18 dias de uso da prótese mandibular reembasada; T3 ­ após 18 dias do restabelecimento da dimensão vertical de oclusão; e T4 e T5 ­ 30 e 100 dias de uso de novas próteses totais. Resultados: Não houve diferenças significativas entre os pontos de tempo para todos os testes eletromiográficos e de força máxima de mordida. O OHIP-EDENT mostrou que o reembasamento pode contribuir para uma maior adaptação da prótese total mandibular e conforto do paciente (T2), em contrapartida T3 foi associado com o desconforto do paciente (p<0.05). Conclusão: Baseado na avaliação de qualidade de vida relacionada à saúde oral, o reembasamento da prótese total mandibular ocasionou um aumento do conforto mastigatório para os pacientes, e o restabelecimento prévio da dimensão vertical de oclusão causou um desconforto para os pacientes. A amplitude eletromiográfica mostrou que as customizações realizadas neste estudo não aumentaram ou diminuíram o esforço mastigatório significativamente. Além disso, todos os valores de força máxima de mordida observados estavam dentro do clinicamente aceitável(AU)

Objective: To evaluate whether customizations of mandibular complete dentures (relining and restoration of the vertical dimension of occlusion) influence the electromyographic amplitude of the masseter and temporal muscles, maximum bite force and oral health-related quality of life of edentulous individuals. Materials and methods: Complete denture wearers who wore the same pair of dentures for more than 5 years were included (without temporomandibular dysfunction) (n=15). Assessments of quality of life (Oral Health Impact Profile for Edentulous ­ OHIP-EDENT), maximum bite force, and electromyography of the masseter and temporal muscles were performed at 5 different times (T1 - original old dentures; T2 - after 18 days of wearing relined mandibular denture; T3 - after 18 days of restoration of the vertical dimension of occlusion; and T4 and T5 - 30 and 100 days of wearing new complete dentures. Results: There were no significant differences between the time points for all electromyographic and maximum bite force tests. The OHIP-EDENT showed that relining can contribute to greater adaptation of the mandibular denture and patient comfort (T2), in contrast, T3 was associated with patient discomfort (p<0.05). Conclusion: Based on the assessment of quality of life related to oral health, the reline of the mandibular complete denture caused an increase in masticatory comfort for the patients, and the previous definitive restoration of the vertical dimension of occlusion caused discomfort for patients. The electromyographic amplitude showed that the customizations performed in this study did not significantly increase or decrease masticatory effort. In addition, all observed maximum bite force values were within the clinically acceptable range(AU)

Restabelecimento da Dimensão Vertical de Oclusão com JIG estético modificado e Prótese Parcial Removível Overlay: relato de caso / Reestablishment of occlusal vertical dimension with a modified aesthetic JIG and an overlay removable partial denture: a case report

A reabilitação de pacientes parcialmente edêntulos com desgaste dentário severo e dimensão vertical de oclusão reduzida é desafiadora e complexa. Objetivo: Descrever o restabelecimento da dimensão vertical de oclusão e parâmetros estéticos com uma prótese parcial removível do tipo overlay (PPRO) com auxílio de um JIG estético modificado. Relato de caso: Paciente do sexo masculino, 58 anos de idade, procurou serviço odontológico queixando-se de insatisfação com a estética do sorriso e perda dos dentes posteriores. Ao exame clínico, foram observados desgaste dentário excessivo e edentulismo parcial nas arcadas superior e inferior. Então, foi proposto tratamento em 2 etapas (provisória e definitiva) com PPRO em maxila. O JIG estético foi usado como guia de referência para incrementos em resina composta fotopolimerizável e o restabelecimento da dimensão vertical de oclusão foi determinado a partir de métodos métrico, fonético e estético. Os dentes desgastados foram aumentados e os dentes ausentes substituídos por dentes artificiais a partir de uma PPRO provisória. Após 2 meses de adaptação, a reabilitação final com PPRO definitiva foi conduzida baseando-se na reabilitação com a PPRO provisória. Conclusão: O paciente relatou satisfação com a estética e desempenho funcional com o tratamento. Portanto, o JIG estético beneficia o planejamento e o tratamento para restabelecer a dimensão vertical de oclusão. Além disso, a PPRO é uma alternativa reversível, de baixo custo, para reabilitar a estética e a função de pacientes com desgaste severo e perda parcial dos dentes.

The rehabilitation of partially edentulous patients with severe tooth wear and reduced occlusal vertical dimension is challenging and complex. Objective: To describe the reestablishment of occlusal vertical dimension and aesthetic parameters with an overlay re-movable partial denture (ORPD) with the aid of a modified aesthetic JIG. Case report: A 58-year-old man sought dental service complaining of dissatisfaction with the aesthetics of his smile and a loss of posterior teeth. At clinical examination, excessive tooth wear and partially edentulism in the lower and upper arches were observed. A two-step treatment (interim and definitive) with an ORPD in the upper arch was proposed. The aesthetic JIG was used as a reference guide for the increments in light-curing resin composite, and the reestablishmentthe occlusal vertical dimension was determined using aesthetic, phonetic, and metric methods. The worn teeth were increased, and the missing natural teeth were replaced by artificial teeth using a temporary ORPD. After two months of adaptation, de-finitive rehabilitation with a definitive ORPD was performed based on the interim ORPD. Conclusion: The patient reported satisfaction with the esthetic and functional performance of this treatment. Therefore, the aesthetic JIG benefits the planning and treatment of reduced vertical dimension. Moreover, the ORPD is a reversible and lower-cost alternative to rehabilitate the aesthetics and function of patients with severe teeth wear and partial teeth loss.

Posiciones Mandibulares de Referencia Clínica. Una Descripción Narrativa

RESUMEN: Las posiciones mandibulares se definen como la relación existente entre la mandíbula y la maxila observada durante su función, o bien posiciones de referencia clínica que pueden ser comparables con otras posiciones o movimientos. Se realizó una descripción narrativa de las posiciones de referencia mandibular de mayor interés clínico, donde se definen algunas de sus principales características; (1) la posición de máxima intercuspidación, está definida por el determinante anatómico dentario, tiene una adecuada reproducibilidad y sencilla ejecución, (2) la posición postural mandibular, es la menos estable, y está definida por el determinante fisiológico neuromuscular, siendo el resultado de la interacción de múltiples factores relacionados, (3) la relación céntrica fisiológica, se considera la posición más estable de la mandíbula, siendo repetible e independiente del contacto dentario, (4) la posición retruida ligamentosa, es una posición extrema por lo que no se considera fisiológica, está determinada por la tensión de la banda horizontal medial del ligamento temporomandibular, (5) la posición retruida de contacto, se describe como la posición mandibular cuando se producen los primeros contactos dentarios y la articulación temporomandibular (ATM) está en una posición retruida, se divide en forzada y no forzada, (6) la posición muscular de contacto es una posición regulada a través de diferentes mecanismos que permiten su estabilidad. Estas posiciones brindan una referencia clínica por medio de la cual se pueden evaluar distintos parámetros necesarios para de realizar diagnósticos y planificación de tratamientos, para ello es importante que el profesional tenga los conocimientos adecuados sobre las características que definen cada una de ellas, tales como su estabilidad y reproducibilidad, que son fundamentales al momento de su ejecución.

ABSTRACT: Mandibular positions are defined as the existing relation between mandibula and maxilla during its function, or it can also be defined as clinical reference positions that may be comparable with other positions or movements. A narrative description of the mandibular reference positions of greatest clinical interest was made, where some of their main characteristics were defined; (1) maximum intercuspal position, is defined by de dental anatomical determinant, it has an adequate reproduction and simple execution, (2) the mandibular postural position, it is the least stable, and it is defined by the neuromuscular physiological elements, being the result of the interaction of multiple factors related, (3) the physiological centric relation is considered the most stable position of the mandible, being easy to repeat and independent of dental contact, (4) the retruded ligamentous position, is an extreme position so it is not considered physiological, and it is determinated by the tension of the medial horizontal band of the temporomandibular ligament, (5) retruded contact position is described as the mandibular position when the first dental contacts are produced and the temporomandibular joint (TMJ) is in a retruded position, it is divided into forced and non- forced, (6) the muscular contact position is a position regulated through different mechanisms that allows its stability. These positions provide a clinical reference by means of which different parameters required while diagnosing and planning treatments can be evaluated, this is why it is important for the Specialist to have specific knowledge about the characteristics that correspond to each one of them, such as its stability and reproducibility, which are fundamental at the time of its execution.

Métodos de Registro de Dimensión Vertical Oclusal en Pacientes Dentados: Revisión Sistemática

RESUMEN: La Dimensión Vertical Oclusal, es la distancia entre un punto anatómico fijo en el maxilar y otro sobre la parte móvil de la mandíbula cuando los órganos dentarios están en contacto oclusal. La obtención de este registro determina el espacio vertical necesario para la rehabilitación de los pacientes. En la actualidad existen distintos métodos para el registro de la Dimensión Vertical Oclusal, en este estudio se analizaron: Métodos fisiológicos y métodos mecánicos. El objetivo fue realizar una revisión sistemática, sobre los métodos de registro, para determinar la Dimensión Vertical Oclusal en pacientes dentados. Se recopiló información científica desde Mayo 2019 hasta Julio 2020 en diferentes bases de datos electrónicas, encontrando un tota l de 13948 artículos, después de eliminar artículos repetidos, por título, por resumen y por metodología PICO se seleccionaron un total de 24 artículos para su análisis y clasificación. Más de un autor menciona que no existe un método unirversalmente aceptado o exacto para determinar la Dimensión Vertical Oclusal. Se sugiere la combinación de varios métodos de registro de Dimensión Vertical Oclusal, se debe de considerar la manera más adecuada para lograr un registro más acertado.

ABSTRACT: Occlusal Vertical Dimension is the distance between an anatomical point in the maxilla and another on the mobile part of the mandible when the teeth are in occlusal contact. Obtaining this record determines the vertical space necessary for the rehabilitation of patients. Nowadays there are different methods for the record of the Occlusal Vertical Dimension, in this study the following were analyzed: physiological methods and mechanical methods. The objective was to do a systematic review of the registration methods to determine the Occlusal Vertical Dimension in dentate patients. Scientific information was collected from May 2019 to July 2020 in different electronic databases, finding a total of 13,948 articles, after eliminating repeated articles, by title, by abstract and by PICO methodology, a total of 24 articles were selected for analysis and classification. More than one author mentions that there is no universally accepted or exact method for determining Occlusal Vertical Dimension. A combination of several methods of Occlusal Vertical Dimension registration is suggested; it should be considered the most appropriate way to achieve a more accurate registration.

Vertical Dimension of Occlusion: A comparative study between Anthropometric and Knebelman's craniometric methods / Dimensión vertical oclusal: un estudio comparativo entre el método antropométrico y el método craneométrico de Knebelman

ABSTRACT The masticatory system changes as time passes. The vertical dimension of occlusion (VDO) undergoes alterations due to temporomandibular joint disorders which in turn may be caused by related muscle modifications or pathological tooth wear. There are many methods to measure VDO. Among these, the anthropometric method and Knebelman's craniometric method have been shown to be the most closely related to facial biotype. The aim of this study was to compare data recorded with those two methods. A descriptive cross-sectional study was performed with a total 200 patients. A vernier caliper was used to measure facial landmarks. Results were analyzed using paired t-test, setting the level of significance at p<0.05. There was no significant difference between the two methods but Knebelman's method had less variability. Results suggest that Knebelman's method should provide more reliability for determining VDO in all the facial biotypes studied.

RESUMEN El sistema masticatorio cambia con el paso del tiempo. La dimensión vertical oclusal sufre alteraciones que se atribuyen a trastornos temporomandibulares a su vez causados por modificaciones en la musculatura relacionada o al desgaste patológico de las piezas dentarias. Existen muchos métodos para medir la dimensión vertical, entre los cuales el método antropométrico y el método craneométrico de Knebelman mostraron ser los más vinculados con el biotipo facial. El objetivo de este estudio fue comparar datos registrados con ambos métodos. La comparación fue realizada mediante un estudio de diseño transversal descriptivo con un total de 200 pacientes, usando un calibrador vernier para realizar mediciones entre puntos faciales establecidos. Los resultados fueron analizados por medio de la prueba de t de Student para datos emparejados estableciendo el nivel de significación en P<0,05. No se encontró diferencia significativa entre los métodos, pero el método de Knebelman mostró generar menos variabilidad en sus medidas. Este último método parece proporcionar más confiabilidad para su aplicación en la determinación de la dimensión vertical oclusal en todos los biotipos faciales estudiados.

Cephalometric evaluation of changes in vertical dimension and molar position in adult non-extraction treatment with clear aligners and traditional fixed appliances

ABSTRACT Introduction: Orthodontists have been using clear aligners to treat malocclusions, and one potential effect of treatment with orthodontic aligners is the intrusion and/or resists extrusion of the posterior teeth. This "bite-block effect" is primarily anecdotal due to the frequent occurrence of posterior open bites in patients after clear aligner therapy. Objective: The purpose of this study was to compare changes promoted by clear aligners and traditional fixed appliances in cephalometric measurements of the vertical dimension and molar position in adult patients with Class I malocclusion treated with non-extraction. Methods: Pre- and post-treatment lateral cephalometric radiographs of adult patients treated with either clear aligners (n=44) or traditional fixed appliances (n=22) were selected for retrospective analysis. Eight interval measurements and one nominal measurement were evaluated: anterior overbite (OB), mandibular plane angle related to cranial base (SN_MP) and related to Frankfort (FMA), lower molar height (L6H) and upper molar height (U6H), palatal plane to mandibular plane angle (PP_MP), lower facial height (LFH), total facial height (TFH), and posterior open bite (Posterior_OB). A single evaluator traced all cephalographs, and changes in select measures of the vertical dimension were compared within and between groups. Results: OB decreased (1.15 mm) and L6H increased (0.63 mm) in the traditional fixed appliance group. Mandibular plane angles (related to cranial base and to Frankfort) increased (0.43° and 0.53°, respectively) in the clear aligner group, but just FMA showed significant difference between groups (difference of 0.53°). LFH and TFH increased (ranging from 0.52 mm to 0.80 mm) in both groups, with no differences between treatment modality. Presence of visible posterior open bite significantly increased over the course of treatment. OB, FMA and L6H exhibited an interaction between treatment stage (pre- and post-treatment) and modality (clear aligner therapy and traditional fixed appliances), but no interaction among these three variables was found. Conclusions: The evidence does not support the theory that clear aligner therapy produces better vertical dimension control than traditional fixed appliances. Traditional fixed appliance therapy slightly extruded the lower molar, and clear aligner therapy produced a slightly mandibular backward rotation.

RESUMO Introdução: Ortodontistas têm usado os alinhadores transparentes para tratar más oclusões, e um potencial efeito desse tratamento é a intrusão e/ou resistência à extrusão dos dentes posteriores. Esse efeito de "bloco de mordida" é principalmente empírico, devido à ocorrência frequente de mordidas abertas posteriores em pacientes após a terapia com alinhadores transparentes. Objetivo: O objetivo do presente estudo foi comparar as mudanças promovidas pelos alinhadores transparentes e aparelho fixo convencional nas medidas cefalométricas de dimensão vertical e posição do molar em pacientes adultos com má oclusão de Classe I tratados sem exodontias. Métodos: Radiografias cefalométricas laterais pré- e pós-tratamento de pacientes adultos tratados com alinhadores transparentes (n=44) ou com aparelho fixo tradicional (n=22) foram selecionadas para uma análise retrospectiva. Oito medidas de intervalo e uma medida nominal foram avaliadas: trespasse vertical anterior (OB), ângulo do plano mandibular em relação à base do crânio (SN_MP) e em relação ao Plano de Frankfurt (FMA), altura do molar inferior (L6H) e altura do molar superior (U6H), ângulo do plano palatal ao plano mandibular (PP_MP), altura facial inferior (LFH), altura facial total (TFH) e mordida aberta posterior (Posterior_OB). Um único avaliador fez todos os traçados cefalométricos, e as mudanças nas medidas da dimensão vertical foram comparadas intra e intergrupos. Resultados: OB reduziu (1,15 mm) e L6H aumentou (0,63 mm) no grupo de aparelho fixo tradicional. Os ângulos do plano mandibular (em relação à base do crânio e ao plano de Frankfurt) aumentaram (0,43° e 0,53°, respectivamente). No grupo dos alinhadores invisíveis, apenas o FMA apresentou diferença significativa entre os grupos (diferença de 0,53º). LFH e TFH aumentaram (variando de 0,52 mm a 0,80 mm) em ambos os grupos, sem diferenças entre as modalidades de tratamento. A presença de uma mordida aberta posterior visível aumentou significativamente durante o curso do tratamento. OB, FMA e L6H exibiram interação entre o estágio do tratamento (pré- e pós-tratamento) e a modalidade (terapia com alinhadores invisíveis ou aparelho fixo tradicional), porém não foi encontrada interação entre essas três variáveis. Conclusões: A evidência não suporta a teoria de que a terapia com alinhadores invisíveis produz melhor controle da dimensão vertical do que o aparelho fixo. O tratamento com aparelhagem fixa extruiu ligeiramente o molar inferior, e o tratamento com alinhadores invisíveis produziu uma ligeira rotação posterior da mandíbula.

Efeitos da reabilitação oral com novas próteses totais convencionais sobre a força de mordida e a amplitude eletromiográfica dos músculos supra-hióideos e esternocleidomastóideos e suas correlações com a dimensão vertical de oclusão / Effects of oral rehabilitation with new conventional complete dentures on bite force and electromyographic amplitude of suprahyoid and sternocleidomastoid muscles and their correlation with vertical occlusal dimension

Objetivos: Analisar os efeitos da reabilitação oral com próteses totais sobre o força máxima de mordida e eletromiografia dos músculos supra-hióideos e esternocleidomastóideo e suas correlações com a DVO. Métodos: Pacientes usuários de próteses totais insatisfatórias participaram em três sessões (T0, T1 e T2). No T0, enquanto os pacientes ainda usavam suas próteses velhas, eles foram submetidos a exames de força de mordida e eletromiografia dos músculos supra-hióideos e esternocleidomastóideos. Novamente, esses exames foram repetidos e a DVO foi medida enquanto os pacientes usavam as suas próteses novas e as velhas, 30 dias após a instalação das novas próteses (T1). Cem dias após a instalação das novas próteses (T2) os exames foram repetidos. Os dados foram submetidos aos testes de normalidade de ShapiroWilk, análise de variância (ANOVA), correlação de Pearson e regressão linear, todos com 5% de significância. Resultados: Quinze pacientes participaram do estudo. Nenhuma diferença estatisticamente significante foi observada para força de mordida e eletromiografia. Porém, os testes de correlação e regressão demonstraram importantes interações entre DVO e força de mordida, e DVO e eletromiografia durante a deglutição para os músculos supra-hióideos. Conclusão: A reabilitação não impactou a força de mordida nem as atividades dos músculos estudados (eletromiografia). Por outro lado, a DVO demonstrou ser um fator importante para força de mordida e deglutição de água após a reabilitação(AU)

Objectives: The purpose of this study was to assess the effects of oral rehabilitation with complete dentures on bite force and electromyography of the suprahyoid and sternocleidomastoid muscles, and their correlation with OVD. Materials and Methods: Patients wearers of unsatisfactory removable complete dentures were attended in three sessions (T0, T1 and T2). At T0, while the patients still wore the old dentures, they were submitted to bite force and surface electromyographic exams of the suprahyoid and sternocleidomastoid muscles. These exams were repeated and the OVD was measured while the patients wore their old and new prostheses, 30 days after insertion of the new prosthesis (T1). The exams were repeated 100 days after the insertion of the new prosthesis (T2). The data were submitted to the ShapiroWilk normality test, analysis of variance (ANOVA), and Pearson correlation and linear regression, all with 5% significance. Results: Fifteen patients participated in the study. No statistically significant difference was observed for bite force or electromyography in T0, T1, or T2. However, the correlation and regression tests showed important interactions between the OVD and bite force, as well as the OVD and electromyography during deglutition for the suprahyoid muscles. Conclusion: Rehabilitation did not impact bite force nor the activity of the assessed muscles (electromyography). On the other hand, OVD was shown to be an important factor for bite force, and deglutition of water after rehabilitation(AU)

Relación entre la dimensión vertical oclusal y la longitud lineal del pabellón auricular / Relationship between occlusal vertical dimension and linear ear length

Resumen Introducción: La dimensión vertical oclusal en algunos casos se altera y para predecirla se suelen utilizar métodos, tanto subjetivos como objetivos y entre los que se encuentran los antropométricos. Objetivo: Evaluar la correlación entre la longitud lineal del pabellón auricular y la dimensión vertical en jóvenes dentados. Métodos: Se evaluaron 47 estudiantes a nivel de la longitud vertical del pabellón auricular (punto más superior al punto más inferior del lóbulo de la oreja), medición del canto exterior del agujero ocular al tragus y la dimensión vertical oclusal (situados en el punto subnasal y en el borde más prominente del mentón). Todas las mediciones se hicieron con un calibrador digital. Resultados: La dimensión vertical oclusal promedio fue de 65,68 ± 4,14 mm. La distancia promedio entre el canto externo del ojo al tragus derecho fue de 67 ± 3,52mm (correlación de r = 0,776; p < 0,01) mientras que en el lado izquierdo fue de 66,95 ± 3,98 mm (correlación de r = 0,733; p < 0,01). La distancia de la longitud del pabellón auricular en el lado derecho fue de 64,74 ± 4,47mm (correlación de r = 0,643; p < 0,01) mientras que en el lado izquierdo fue de 64,84 ± 4,46 mm (correlación de r = 0,657; p < 0,01). Conclusiones: Las medidas antropométricas de la longitud lineal del pabellón auricular derecho e izquierdo se correlacionó con la dimensión vertical oclusal así como la medición entre el canto externo del ojo al tragus también se correlación con la dimensión vertical oclusal(AU)

ABSTRACT Introduction: When occlusal vertical dimension becomes altered, as is sometimes the case, use should be made of subjective and objective methods, including those based on an anthropometric approach. Objective: Evaluate the correlation between linear ear length and vertical dimension in dentate young subjects. Methods: A total 47 students were evaluated for linear vertical ear length (from the highest to the lowest end of the earlobe), and measurements were taken from the outer edge of the ocular hole to the tragus and the vertical occlusal dimension (located at the subnasal point and the most prominent edge of the chin). All measurements were taken with a digital caliper. Results: Average vertical occlusal dimension was 65.68 ± 4.14 mm. Average distance from the outer edge of the eye to the right tragus was 67 ± 3.52 mm (r correlation = 0.776; p < 0.01), whereas on the left side it was 66.95 ± 3.98 mm (r correlation = 0.733; p < 0.01). Ear length distance was 64.74 ± 4.47 mm on the right side (r correlation = 0.643; p < 0.01) and 64.84 ± 4.46 mm on the left side (r correlation = 0.657; p < 0.01). Conclusions: Right and left linear ear length anthropometric measurements correlated with vertical occlusal dimension. The distance from the outer edge of the eye to the tragus also correlated with the vertical occlusal dimension(AU)

Factores morfofuncionales de interés en prostodoncia que dependen de los biotipos craneofaciales / Morphofunctional factors of interest in prosthodontics depending on the craniofacial biotypes

El presente es un trabajo de investigación bibliográfica que busca establecer la posibilidad de utilizar las cefalometrías como elementos de diagnóstico pronóstico y elaboración de prótesis. Centra su objeto de estudio en encontrar y clasificar los factores morfológicos y funcionales que varían con los biotipos craneofaciales y que son de interés en la prostodoncia. La metodología empleada fue la revisión de la literatura histórica hasta la actualidad en la que se relacionan temas de prostodoncia a los biotipos craneofaciales. Si bien solo dos autores relacionaron la prostodoncia con los biotipos cráneo faciales, sí se encontraron varios temas de interés asociados directamente a la prostodoncia. Se clasificaron en temas de oclusión: Curva de Spee, plano de oclusión, movimientos mandibulares, dimensión vertical oclusiva y de especio libre interoclusal. Tema de maloclusiones. Tema de fuerza muscular. Tema variaciones morfológicas de procesos alveolares, corticales ósea y de la forma dentaría. Encontrándose para cada uno de ellos alguna correlación positiva con los distintos tipos faciales. De este estudio, se concluye que es necesario sistematizar el estudio de los conocimientos que puede aportar la cefalometría como una importante herramienta de diagnóstico al prostodoncista a partir de haberse encontrado variaciones muy importantes en los aspectos mencionados que hacen al interés de la rehabilitación prostodóncica (AU)

This Work is a bibliographic research that seeks to establish the use of cephalometries as elements of diagnosis prognostic and prosthesis elaboration. Its focus is to find and classify morphological and functional factors that vary with facial types which are of interest in prosthodontics. This was a review of the historical literature to date, in which prosthodontics are related to facial types. Although only two authors related prosthodontics to facial ypes, they did find several topics of interest directly associated with prosthodontics. They were classified into occlusion themes: Spee curve, occlusion plane, mandibular movements, occlusive vertical dimension and interocclusal free space. Malocclusion issue. Muscle strength theme. Morphological variations of alveolar processes, cortical bone and dental morphology. They found some positive correlation with the different facial types for each of them. From this study, it is concluded that it is necessary to systematize the study of cephalometries because they can provide to be an important diagnostic tool to the prosthodontist because there were found very important variations in the mentioned aspects that are of interest in prosthodontic rehabilitation (AU)

Restablecimiento oclusal mediante procedimientos multidisciplinarios / Occlusal restoration by multidisciplinary procedures

RESUMEN Introducción: El edentulismo es la pérdida total o parcial de dientes, ocasionado principalmente por la caries y la enfermedad periodontal; es un proceso gradual que está comúnmente asociado al aumento de edad. Actualmente es considerado una discapacidad debido a la limitación funcional que ocasiona en quien lo presenta. Objetivo: Exponer el tratamiento rehabilitador multidisciplinario, funcional y estético en un paciente con desarmonías oclusales. Presentación del caso: Paciente masculino de 74 años, diagnosticado con edentulismo parcial bimaxilar, mediante examen clínico y radiológico. Se sometió a terapia periodontal generalizada, cirugía preprotésica, restauración de plano oclusal de forma directa e indirecta y rehabilitación bucal con prótesis removibles total superior y parcial inferior; lo cual le permitió recuperar funcionalidad, estética y autoestima. Conclusiones: El edentulismo desencadena alteración en el estado funcional y emocional del paciente. Un diagnóstico integral y plan de tratamiento multidisciplinario y ordenado desencadenó éxito en el presente caso(AU)

ABSTRACT Introduction: Edentulism is total or partial tooth loss mainly caused by dental caries and periodontal disease. It is a gradual process often associated to aging. At present edentulism is considered to be a disability, due to the functional limitations undergone by sufferers. Objective: Describe the multidisciplinary, functional and esthetic rehabilitation treatment provided to a patient with occlusal disharmony. Case presentation: A 74-year-old male patient was diagnosed with bimaxillary partial edentulism based on clinical and radiographic examination. The patient underwent generalized periodontal therapy, pre-prosthetic surgery, direct and indirect occlusal plane restoration, and oral rehabilitation with total upper and partial lower removable prostheses, as a result of which he recovered his functionality, esthetic appearance and self-esteem. Conclusions: Edentulism triggers changes in the functional and emotional state of patients. Comprehensive diagnosis and orderly multidisciplinary treatment led to success in the case herein presented(AU)

Full mouth rehabilitation on the patient with deep bite and posterior bite collapse using re-establishment of occlusal vertical dimension / 대한치과보철학회지

The loss of posterior support and the abnormal jaw relation can cause pathologic findings. If deep bite patients with multiple missing teeth, can not have the stable posterior contact, the mandible moves posteriorly, and consequently the overjet and overbite get worse. And when the mandibular irregular occlusal plane is corrected, it is easier to have the bilateral balanced occlusion with the maxilla. So the treatment goal is to give proper posetrior support and establish appropriate anterior guidance, and ultimately provide improved mastication and esthetics recovery. In this case, a 68 year old man, having deep bite without posterior support was evaluated by the vertical dimesion decision flow-chart. An available prosthetic height, anterior occlusal relation such as overjet, overbite and the esthetic part such as facial height and the cephalometric analysis are the factors to be considered.

Full mouth rehabilitation of a severely worn dentition using intraoral scanner and the CAD/CAM double scanning technique / 대한치과보철학회지

With the evolution of the computer-aided design/computer-aided manufacturing (CAD/CAM) technology, the intraoral scanners are playing an increasingly important role, as they are the first step towards a completely digital workflow. The CAD/CAM double scanning technique has been used to transfer the information from provisional restorations to definitive restorations. In this case, a 67-year-old male with esthetically compromised anterior teeth, generalized severe attrition of teeth, and reduced vertical dimension was treated with full mouth rehabilitation including a re-establishment of the lost vertical dimension of occlusion assisted by the crown lengthening procedure. The provisional restorations were fabricated using an intraoral scanner and the CAD/CAM double scanning technique. After the period of adaption, the definitive monolithic zirconia restorations were delivered. The CAD/CAM double scanning technique successfully transferred the occlusal and morphological characteristics, obtained from the provisional restorations, to the definitive restorations.

Variaciones del tercio inferior de la cara, disturbios temporomandibulares y necesidades asistenciales / Variations of the lower third of the face and temporomandibular disorders: needs of health care

RESUMEN Introducción: la articulación temporomandibular es una de las estructuras craneofaciales más complejas, mantiene una íntima relación con el sistema neuromuscular, tónico postural y la oclusión dentaria. Objetivo: identificar las variaciones verticales del tercio inferior de la cara, su relación con trastornos temporomandibulares y las necesidades asistenciales. Métodos: se realizó un estudio observacional, descriptivo y transversal en el período comprendido de enero del 2017 a febrero 2018, en la Clínica Estomatológica Docente "Antonio Briones Montoto". El universo estuvo constituido por 803 estudiantes de las secundarias básicas del área de salud próxima al centro, la muestra quedó constituida por 256 escolares. El análisis de los datos se realizó en tablas de distribución de frecuencias y se procesaron mediante técnicas estadísticas. Resultados: el 14,8 % de los escolares examinados presentó proporción facial, un 33,9 % presentó disminución del tercio inferior y un 51,1 % el tercio inferior aumentado, prevalecieron los adolescentes con disturbios temporomandibulares para un 52,3 % predominando el tercio inferior de la cara aumentado, asociado a esta alteración, el Síndrome de clase I de Moyers se presentó en un 24,2 % y el Síndrome clase II de Moyers en un 18,3 %, relacionado a los disturbios de la articulación temporomandibular, el tratamiento correctivo fue la mayor necesidad para un 47,4 %. Conclusiones: el tercio inferior aumentado fue la mayor alteración determinada, al presentar una relación estadísticamente significativa con los disturbios de la articulación temporomandibular independientemente del sexo, el síndrome de clase I de Moyers predominó y el tratamiento ortodóncico correctivo fue la mayor necesidad asistencial.

ABSTRACT Introduction: temporomandibular joint is one of the most complex craniofacial structures; it maintains a close relationship with the neuromuscular, postural-tonic systems and the dental occlusion. Objective: to identify the vertical variations of the lower third of the face, its relationship with temporomandibular disorders and care needs. Methods: an observational, descriptive and cross-sectional study was conducted in the period from January 2017 to February 2018, at the "Antonio Briones Montoto" Teaching Stomatological Clinic. The universe was constituted by 803 students of the basic secondary schools of the health area near the center, the sample was constituted by 256 schoolchildren. The data analysis was performed in frequency distribution tables and processed using statistical techniques. Results: of the students examined 14,8 % presented facial proportion, 33,9 % showed a decrease in the lower third and 51,1 % in the lower third increased, adolescents with temporomandibular disorders prevailed 52,3 % with the lower third of the increased face predominating the association with this disorder, 24,2 % of them presented Moyers Class I Syndrome and 18,3 % Moyers Class II Syndrome related respectively to temporomandibular joint disorders, corrective treatment was most needed ( 47,4 %). Conclusions: the increased lower third was the greatest disorder determined presenting a statistically significant relationship with temporomandibular joint disorders regardless of gender, the Moyers class I syndrome was the most predominant and corrective orthodontic treatment showing the greatest need for health care.

Altering Vertical Dimension: A Literature Review / Alteración de la dimensión vertical: Revisión de la literatur a

The alteration of the vertical dimension it's been a controversial issue for more than 50 years, today is not known an exact protocol to determine what is the right vertical dimension for each person and the appropriate variation to which you can submit a patient without causing any type of joint, muscle, functional or aesthetic alteration. In this review, we show the different concepts and criteria that must be taken into account in order to carry out successful treatments, whether in dentate, partially edentulous or totally edentulous patients to determine a vertical dimension that adapts to each patient through parameters such as facial aesthetics, health of the temporomandibular joint, occlusion and phonetics.

La alteración de la dimensión vertical es un tema controvertido desde hace más de 50 años, al día de hoy no se conoce un protocolo exacto para determinar qué es la dimensión vertical adecuada para cada persona y la variación adecuada de esta a la que se puede alguna vez un paciente sin provocar algún tipo de alteración articular, muscular, funcional o estética. En este artículo de revisión de tema, se muestran los diferentes conceptos y criterios que se deben tener en cuenta para llevar a cabo el éxito los tratamientos que se realizan ya sea en pacientes dentados, editados o totalmente editados para determinar una dimensión vertical que se adaptan a cada paciente mediante parámetros como la estética facial, la salud de la articulación temporomandibular, oclusión y fonética.

Relationship between the occlusal vertical dimension and anthropometric measurements of the fingers / Relación entre la dimensión vertical oclusal y las medidas antropométricas de los dedos de la mano

The alteration of the vertical dimension can deteriorate the facial harmony, and it can be measured through objective and subjective methods, although many of which are not reliable. Objective: Relate the anthropometric fingers length with the measurement of the vertical occlusal dimension (VOD). Material and Methods: Cross-sectional, observational study that included 114 students from the School of Dentistry with class I malocclusion and complete dentition. The VOD was evaluated as the measurement between the subnasal points and the mental point; anthropometric measures included the length of the fingers (from the most mesial fold to the most distal edge) and the distance projected between the thumb and the index finger. Results: The average VOD was 64.03±5.15mm. A correlation was found between the VOD and the index finger length (p<0.01, r=0.29), between the VOD and middle finger length (p<0.01, r=0.31) and correlation between the VOD and the length of the little finger (p<0.05, r=0.23). No correlation was found between the VOD and the ring finger lengths (p= 0.051) or thumb (p=0.12). Conclusions: The anthropometric measurements of the index finger, middle finger, little finger and the projection of the thumb on the index finger correlated with the length of the vertical occlusal dimension.

La alteración de la dimensión vertical puede deteriorar la armonía facial, su medición puede realizar a través de métodos objetivos y subjetivos; sin embargo muchos de ellos no son confiables. Objetivo: Relacionar las longitudes antropométricas de los dedos de la mano con la medida de la dimensión vertical oclusal (DVO). Material y Métodos: Estudio transversal, observacional que incluyó a 114 estudiantes de la Facultad de Odontología con maloclusión de clase I y dentición completa. La DVO fue evaluada como la medida entre los puntos subnasal al punto mentoniano; las medidas antropométricas incluyeron a la longitud de los dedos (desde su pliegue más mesial hasta su borde más distal) y la distancia proyectada entre el pulgar al índice. Resultados: La DVO promedio fue de 64,03±5,15mm. Se encontró correlación entre la DVO y la longitud del dedo índice (p<0,01; r=0,29), entre la DVO y la longitud del dedo medio (p<0,01; r=0,31) y correlación entre la DVO y la longitud del dedo meñique (p<0,05; r=0,23). No se encontró correlación entre la DVO y las longitudes de los dedos anular (p=0,051) y pulgar (p=0,12). Conclusiones: Las medidas antropométricas del dedo índice, medio, meñique y la proyección del dedo pulgar sobre el dedo índice se correlacionaron con la longitud de la dimensión vertical oclusal.