Morphometric evaluation, locational relationship, and surgical significance of the maxillofacial region landmarks / Evaluación morfométrica, relación de ubicación e importancia quirúrgica de los puntos de referencia de la región maxilofacial

SUMMARY: The aim of this study was to examine the localization of the landmarks in the maxillofacial region and their relations with each other and to evaluate them morphologically and clinically. Our study included 41 dry adult human skulls of unknown age and sex of Anatolian population. Statistical analysis of the data obtained in our study was performed with SPSS v.20.0 software (IBM Corp., Armonk, NY, USA). Statistical significance was accepted as P ? 0.05. Whereas the mean right supraorbital depth (SOD) value was significantly greater than the mean left SOD value (p 0.05). Correlation values in our study varied between -0.156 and 0.612. The highest correlation value was obtained in the positive direction between the orbital height (OH) and supraorbital foramen-infraorbital foramen (SOF-IOF) measurements (r = 0.612, p < 0.001). We believe that measurements of the orbit, SOF, and IOF and our data on their localizations, along with the relationships that we observed in our study will allow surgeons to avoid damaging the neurovascular bundles during surgical interventions and local anesthesia procedures in the frontal, periorbital, and maxillofacial regions.

RESUMEN: El objetivo de este estudio fue examinar la localización de los hitos en la región maxilofacial y sus relaciones entre sí y evaluarlos morfológica y clínicamente. Nuestro estudio incluyó 41 cráneos humanos adultos secos de edad y sexo desconocidos de la población de Anatolia. El análisis estadístico de los datos obtenidos en nuestro estudio se realizó con el software SPSS v.20.0 (IBM Corp., Armonk, NY, EE. UU.). La significación estadística se aceptó como P ? 0,05. Mientras que el valor medio de la profundidad supraorbitaria derecha (SOD) fue significativamente mayor que el valor medio de la SOD izquierda (p 0,05). Los valores de correlación en nuestro estudio variaron entre -0,156 y 0,612. El mayor valor de correlación se obtuvo en la dirección positiva entre las medidas de altura orbitaria (OH) y foramen supraorbitario-foramen infraorbitario (SOF-IOF) (r = 0,612, p <0,001). Creemos que las mediciones de la órbita, SOF e IOF y nuestros datos sobre sus localizaciones, junto con las relaciones que observamos en nuestro estudio, permitirán a los cirujanos evitar dañar los haces neurovasculares durante las intervenciones quirúrgicas y los procedimientos de anestesia local en la zona frontal, periorbitaria. y regiones maxilofaciales.

Can human maxillary premolars discriminate between sexes in South Asian populations? / ¿Pueden los premolares maxilares humanos discriminar entre sexos en las poblaciones del sur de Asia?

The studies have illustrated odontometric analysis can be used to determine the sexual dimorphism effect on size of the teeth in various populations. The main aim of the study was to identify the inter-cuspal-, bucco-lingual -dimensions and weight of human upper-arch pre-molars in males and females of different South Asian populations. These metrics can distinguish sex which can have application in mass disasters, archaeology of mingled human remains and the in unidentified or several ancestry. The sample size consisted of 60 orthodontically extracted maxillary pre-molars from Pakistani and Saudi Arabian populations respectively. For male and female groups of each population fifteen first and second maxillary premolars were collected respectively, stored in PBS solution. The weight of the individual teeth was recorded. Later, digitally pictures were captured parallel to the occlusal surface to measure maximal bucco-lingual and inter-cuspal dimensions using Image-J software. The dimensions and weights were compared using Students' t-test between males and females respective Pakistani and Saudi Arabian first (P1) and second (P2) maxillary pre-molars. The dimensions for male P1 and P2 were statistically significantly larger than that for females in both populations. Furthermore, wet-weight of pre-molars in males is significantly greater than females in both populations. The findings demonstrate maxillary pre-molars can discriminate between the sexes in various populations.

Las investigaciones han ilustrado que el análisis odontométrico se puede utilizar para determinar el efecto del dimorfismo sexual en el tamaño de los dientes en varias poblaciones. El objetivo principal del estudio fue identificar las dimensiones y el peso entre cúspides, buco-linguales y el peso de los premolares de la arcada superior humana en hombres y mujeres de diferentes poblaciones del sur de Asia. Estas medidas pueden distinguir el sexo y ser importante en desastres masivos, arqueología de restos humanos entremezclados y en ancestros no identificados. El tamaño de la muestra consistió en 60 premolares maxilares extraídos ortodóncicamente de las poblaciones de Pakistán y Arabia Saudita, respectivamente. Para los grupos de hombres y mujeres de cada población, se recogieron quince primeros y segundos premolares superiores respectivamente, almacenados en solución de PBS. Se registró el peso de los dientes individuales. Posteriormente se capturaron imágenes digitales paralelas a la superficie oclusal para medir las dimensiones máximas buco-linguales e intercúspides utilizando software Image-J. Las dimensiones y los pesos se compararon mediante la prueba t de Student entre lo premolares maxilares (P1) y segundos (P2) de hombres y mujeres paquistaníes y saudíes. Las dimensiones para P1 y P2 de los hombres fueron estadísticamente significativos mayores que para las mujeres en ambas poblaciones. Además, el peso húmedo de los premolares en los varones era significativamente mayor que el de las mujeres en ambas poblaciones. Los hallazgos demuestran que los premolares maxilares pueden discriminar entre los sexos en varias poblaciones.

Evaluación del Índice de Korkhaus en adultos chilenos con oclusión normal / Evaluation of Korkhaus Index in Chilean adult individuals with normal occlusion

El examen de modelos es una de las múltiples herramientas diagnósticas que posee la ortodoncia y ortopedia dentomáxilofacial. Los valores con que se construyó su norma estadística están basados en poblaciones específicas y no reflejan las diferencias morfológicas existentes en el complejo cráneofacial entre las distintas etnias. El propósito de esta investigación fue identificar las longitudes transversales y sagitales de los maxilares de la población adulta mestiza chilena con oclusión normal y compararlas con el índice de Korkhaus basado en una población adulta caucásica alemana. Se reclutaron 20 estudiantes de pregrado de la Facultad de Odontología de la Universidad de Valparaíso con oclusión normal. Se registraron ambas arcadas dentarias con yeso y se aplicó el índice de Korkhaus: se midió la longitud interpremolar, la longitud intermolar, la longitud anterior superior y la longitud anterior inferior. La comparación entre los valores de la muestra y los valores referenciales del índice de Korkhaus fue hecha con la prueba de rangos de Wilcoxon mediante el software estadístico STATA 15.0 y se consideraron significativos valores de p<0,05. Se encontró una diferencia estadísticamente significativa en el valor de la longitud anterior superior (p-0,013); para la longitud interpremolar (p-0,9552) la longitud intermolar (p-0,8223) y la longitud anterior inferior (p-0,0452) no se hallaron diferencias. La mayor magnitud de la longitud anterior superior de la arcada dentaria respecto a la población adulta caucásica alemana se debe al rasgo de protrusión dentaria presente en la población mestiza chilena, lo cual no altera las características de una oclusión normal.

The model exam is one of many diagnostic tools in orthodontics and dentomaxillofacial orthopedics. The values on which the statistical norm were constructed, are based on specific populations and they do not reflect the morphological differences in the craniofacial complex between the different ethnic groups. The purpose of this study was to identify the transverse and sagittal maxillary and mandibular lengths of the Chilean mestizo adult population with normal occlusion, and compare them with the Korkhaus index based on a German Caucasian adult population. For this study 20 undergraduate students with normal occlusion were recruited from the Faculty of Dentistry of the University of Valparaíso. Both upper and lower dental casts were obtained from each student, and Korkhaus index was applied: the interpremolar length, intermolar length, upper anterior length and lower anterior length were measured. Comparison between the values of the sample and the reference values of the Korkhaus index was made with the Wilcoxon range test using the STATA 15.0 statistical software and significant values of p <0.05 were considered. A statistically significant difference was found in the value of the upper anterior length (p-0.013); for the interpremolar length (p-0.9552) the intermolar length (p-0.8223) and the lower anterior length (p-0.0452) no differences were found. The greater magnitude of the dental arch upper anterior length compared to the German Caucasian adult population is due to dental protrusion present in the Chilean mestizo population, which does not affect the normal occlusion characteristics.

Expansión palatina rápida asistida con mini implantes / Rapid palatal expansion assisted by mini-screws

La atresia o estrechez del maxilar superior es una patología que observamos frecuentemente en nuestra práctica diaria. Es importante el diagnóstico a una edad temprana, no solo para resolver ortopédicamente dicha patología, sino también prevenir una posible cirugía ortognática en la adultez. La expansión palatina rápida es un recurso terapéutico ortopédico para la corrección de la discrepancia transversal esqueletal del maxilar superior, que se manifiesta clínicamente como mordida invertida posterior. Existen diversos tipos de disyuntores y técnicas para su realización. La llegada del anclaje absoluto con los mini-implantes abrió puertas que revolucionan conceptos clásicos de expansión.

Atresia or narrowing of the maxilla is a pathology that we frequently observe in our daily practice. It is important to diagnose at an early age, not only to solve orthopedically this pathology, but also to prevent a possible orthognathic surgery at an adult age. Rapid palatal expansion is an orthopedic therapeutic resource for the correction of the skeletal transverse discrepancy of the maxilla. This pathology manifests clinically as a posterior crossbite. There are different types of expanders and techniques for their realization. The arrival of the absolute anchorage with the mini-implants opened doors that revolutionized classic concepts of expansion

Central Cemento-Ossifying Fibroma: Clinical Imaging and Histopathological Diagnosis / Fibroma Cemento-Osificante Central: Diagnóstico Clínico, Imagenológico e Histológico

ABSTRACT: Central ossifying fibroma is a lesion in which diagnosis has proved intriguing and unclear for presenting clinical, radiographic, and even histopathological similarities to other types of lesions such as the fibrous dysplasia of bone and cement-bone dysplasia. It is a benign neoplasm of uncertain etiology and slow development in which the mandible is affected more frequently than the maxilla. We described a case of central cemento-ossifying fibroma involving the right mandible of a thirty-five-female patient by presenting its clinical, radiographic, and histological characteristic sand discussing some differential diagnoses.

RESUMEN: El fibroma cemento-osificante central es una lesión que requiere un diagnóstico diferencial ya que muestran similitud clínica, histológica y radiológica con la displasia fibrosa y con la displasia cemento-ósea. Esta lesión es un tumor benigno de etiología incierta, presenta crecimiento lento y afecta principalmente la mandíbula más que el maxilar. Se reporta un caso de un paciente de sexo femenino de 35 años, diagnosticada con fibroma cementoosificante central que le afectó el lado derecho de la mandíbula. Se describen las características clínicas, histológicas y radiológicas de la paciente y se discuten los diversos diagnósticos diferenciales.

Evaluation of Damon system effects in alveolar bone support by cone-beam computed tomography (CBCT) / Avaliação dos efeitos do sistema Damon no suporte ósseo dentário por meio da tomografia computadorizada de feixe cônico (TCFC)

Introduction: The aim of this study was to assess changes in buccal bone thickness, buccolingual inclinations and transversal width of teeth during treatment with the Damon System. Material and Methods: Twenty-one patients of both sexes, with a mean initial age of 14.99 ± 1.27 years, with complete permanent dentition up to second molars, treated with no extractions and minimum initial crowding of 4mm (maxillary: - 6.71mm (SD 2.99), mandibular: -5.12 mm (SD 2.03)) were taken to CBCT scan before (T1) and after (T2) orthodontic treatment with the Damon System. In the maxilla, buccal bone thickness was measured at 4mm and 6mm from the cementoenamel junction of the right first molar in the apical direction. For the mandible, the same protocol was used, but the axial sections were performed at 4mm and 8mm. Buccolingual inclinations were verified using CBCT-panoramic cross-sectionals based on the image that presented the most appropriate view of buccal face of the clinical crown. Transversal width measurements were performed in intermolar, intersecond premolar, interfirst premolar and intercanine distances by 3D multiplanar reconstruction in the two-time periods. Distribution of the variables was verified by Shapiro-Wilk test. Changes in all variables from T1 to T2 were compared using paired t-test. The correlation between changes in bone thickness, buccolingual inclinations and transversal width was assessed by Pearson correlation coefficient. Results: At 4mm height, treatment with Damon System produced a statistically significant decrease in buccal bone thickness, mainly in the posterior teeth of the maxillary and mandibular arches. At 8mm, there was a statistically significant decrease in buccal bone thickness only in mandibular molar and premolar teeth. Regarding buccolingual inclinations, a statistically significant increase was observed in the maxillary arch, mainly in the incisors and premolars teeth. In the mandibular arch, all teeth showed a statistically significant increase of buccal inclination, except for the left canine and first molar. Concerning transversal width, there was a statistically significant increase in maxillary and mandibular transversal width at the end of treatment, exception of the maxillary canines. Conclusion: In general, orthodontic treatment with the Damon self-ligating brackets system showed an expansion of the dental arches followed by a decrease in buccal bone thickness, caused by buccal inclination of dental crowns in both arches.(AU)

Introdução: O objetivo do presente estudo foi avaliar as alterações nas espessuras das tábuas ósseas vestibulares, nas inclinações dentárias e nas dimensões transversais dos arcos durante o tratamento com o Sistema Damon de braquetes autoligáveis. Materiais e Métodos: Vinte e um adolescentes de ambos os gêneros com idade média de 14,99 ± 1,27 anos, dentadura permanente completa até os segundos molares, tratados sem extrações e apinhamento inicial mínimo de 4mm (superior: -6,71mm (DP 2,99), inferior: -5,12mm (DP 2,03) foram submetidos a exames de Tomografia Computadorizada de Feixe Cônico (TCFC) antes (T1) e após (T2) o tratamento ortodôntico com o Sistema Damon. A espessura da tábua óssea vestibular da maxila foi determinada por cortes axiais nas distâncias de 4mm e 6mm localizados apicalmente à junção amelocementária do primeiro molar superior direito. Para a mandíbula, foi realizado o mesmo protocolo, porém os cortes axiais selecionados foram realizados nas distâncias de 4mm e 8mm apicalmente à junção amelocementária do primeiro molar inferior direito. Para mensuração das inclinações dentárias, foram utilizados cortes parassagitais gerados a partir da imagem panorâmica da TCFC. As medidas foram realizadas a partir do ângulo formado pela linha vestibular da coroa clínica (LVCC) e a borda superior ou inferior da imagem selecionada. As dimensões transversais dos arcos (6-6/5-5/4-4/3-3) foram mensuradas por meio de cortes axiais das reconstruções 3D. As variáveis foram submetidas ao teste de Shapiro-Wilk para testar sua distribuição. As alterações de todas as variáveis de T1 para T2 foram comparadas por meio dos testes t-pareado. A correlação entre as alterações das espessuras ósseas com as alterações nas inclinações dentárias e dimensões transversais dos arcos foi verificada pelo coeficiente de correlação de Pearson. Resultados: o tratamento com o Sistema Damon produziu uma diminuição estatisticamente significante na espessura da tábua óssea vestibular predominantemente na região posterior dos arcos superior e inferior no corte realizado a 4mm. Nos cortes realizados a 8mm, houve uma diminuição estatisticamente significante na espessura óssea vestibular somente na região de molares e premolares inferiores. Em relação as inclinações vestibulolinguais dos dentes, um aumento estatisticamente significante foi observado no arco superior, com predomínio nos incisivos e premolares. No arco inferior, todos os dentes mostraram um aumento estatisticamente significante da inclinação para vestibular, com exceção do canino e primeiro molar esquerdos. As dimensões transversais dos arcos superiores e inferiores sofreram um aumento estatisticamente significante ao final do tratamento com o Sistema Damon, com exceção dos caninos superiores. Conclusão: De maneira geral, o tratamento ortodôntico com o Sistema Damon de braquetes autoligáveis produziu um aumento nas dimensões transversais seguida por uma redução da espessura óssea na parede vestibular dos dentes, ocasionada pela inclinação vestibular das coroas dentárias em ambos os arcos.(AU)

The duration of pubertal growth peak among three skeletal classes

ABSTRACT Introduction: Pubertal growth peak is closely associated with a rapid increase in mandibular length and offers a wide range of therapeutic modifiability. Objective: The aim of the present study was to determine and compare the mean ages of onset and duration of pubertal growth peak among three skeletal classes. Methods: A retrospective cross-sectional study was conducted using lateral cephalograms of 230 subjects with growth potential (110 males, 120 females). Subjects were categorized into three classes (Class I = 81, Class II = 82, Class III = 67), according to the sagittal relationship established between the maxilla and the mandible. The cervical vertebral maturation stage was recorded by means of Baccetti's method. The mean ages at CS3 and CS4 and the CS3-CS4 age interval were compared between boys and girls and among three skeletal classes. Results: Pubertal growth peak occurred on average four months earlier in girls than boys (p = 0.050). The average duration of pubertal growth peak was 11 months in Class I, seven months in Class II and 17 months in Class III subjects. Interclass differences were highly significant (Cohen's d > 0.08). However, no significant difference was found in the timing of pubertal growth peak onset among three skeletal classes (p = 0.126 in boys, p = 0.262 in girls). Conclusions: Girls enter pubertal growth peak on average four months earlier than boys. Moreover, the duration of pubertal growth peak is on average four months shorter in Class II and six months longer in Class III subjects as compared to Class I subjects.

RESUMO Introdução: o pico de crescimento puberal está intimamente relacionado a um rápido aumento no comprimento da mandíbula e propicia uma larga gama de abordagens terapêuticas. Objetivos: o objetivo do presente estudo foi determinar e comparar as idades médias ao começo do pico de crescimento puberal, bem como sua duração, nas três diferentes classes esqueléticas. Métodos: esse estudo retrospectivo transversal foi conduzido usando radiografias celafométricas laterais de 230 indivíduos com potencial de crescimento (110 homens, 120 mulheres). Os indivíduos foram categorizados em 3 classes (Classe I = 81, Classe II = 82, Classe III = 67), conforme a relação sagital presente entre a maxila e a mandíbula. O estágio de maturação cervical foi registrado por meio do método de Baccetti. As idades médias em EMVC3 e EMVC4, bem como o intervalo de idade EMVC3-EMVC4 foram comparados entre meninos e meninas e entre as três classes esqueléticas. Resultados: o pico de crescimento puberal ocorreu, em média, quatro meses mais cedo nas meninas do que nos meninos (p = 0,050). A duração média do pico de crescimento puberal foi de 11 meses nos indivíduos Classe I, 7 meses nos indivíduos Classe II e de 17 meses nos indivíduos Classe III. As diferenças interclasses foram altamente significativas (d de Cohen > 0,08). Porém, não foram identificadas diferenças significativas quanto à época de início do pico de crescimento puberal entre as três classes esqueléticas (p = 0,126 nos garotos, p = 0,262 nas garotas). Conclusões: as meninas entram no pico de crescimento puberal, em média, quatro meses antes dos meninos. Além disso, a duração do pico de crescimento puberal é, em média, quatro meses menor em indivíduos Classe II e seis meses maior nos indivíduos Classe III, em comparação aos indivíduos Classe I.

Histological aspects of the mucosa of the spermaceti chamber of a dwarf sperm whale / Aspectos histológicos da mucosa da câmera do espermacete de cachalote-anão

The sound producing apparatus of the dwarf sperm whale (Kogia sima) presents a complex anatomic structure composed of melon, spermaceti, phonic lips, vocal cap, case, papillae, spermaceti chamber and other airspaces, as well as facial muscles involved in sound production. The spermaceti chamber rests on the caudal portion of the premaxilla, with part of its mucosa covered with spherical/oval-shaped structures (approximately 1 to 2 mm in diameter), compatible with vesicles (previously referred to as "papillae"). Macroscopical examination revealed whitish, firm, widely and irregularly distributed vesicular mucosa on the premaxillary portion of the spermaceti chamber of a K. sima specimen stranded on the coast of Santos (southeastern Brazilian coast). Upon microscopic examination, walls of connective tissue with abundant type I collagen forming vesicles with an internal space or cavity filled with a small amount of eosinophilic substance compatible with mucoproteic fluid were observed. The base of such vesicles presented glands within the connective tissue, probably responsible for fluid production. This study describes the histology of the mucosa of the spermaceti chamber of a K. sima specimen and characterizes the glands associated with fluid production.(AU)

O sistema de produção sonora do cachalote-anão (Kogia sima) apresenta uma complexa estrutura anatômica composta por melão, espermacete, lábios fônicos, "vocal cap", "case", papilas, câmara do espermacete e outros espaços aéreos, além de músculos faciais envolvidos na produção sonora. A câmara do espermacete localiza-se na porção caudal da pré-maxila, apresentando parte de sua mucosa recoberta por estruturas esférico-ovaladas de aproximadamente 1 a 2 mm de diâmetro, compatíveis com vesículas (previamente denominadas "papilas"). Ao exame macroscópico de um espécime de K. sima encalhado no litoral de Santos (sudeste da costa brasileira), foi identificada mucosa esbranquiçada e firme ao corte, ampla e irregularmente distribuída na porção pré-maxilar da câmara do espermacete. Ao exame microscópico foram observadas vesículas compostas por abundante tecido conectivo de colágeno tipo I, dando origem a um espaço interno ou cavidade, contendo pequena quantidade de substância eosinófila, compatível com fluido mucoprotêico. Estruturas glandulares foram observadas em tecido conjuntivo na base das vesículas, provavelmente responsáveis pela produção do fluido observado no interior das mesmas. Esse estudo caracteriza histologicamente a mucosa da câmara do espermacete de um espécime de K. sima e as glândulas relacionadas a sua produção secretória.(AU)

Jaw musculature of Cyclarhis gujanensis (Aves: Vireonidae) / Musculatura das maxilas de Cyclarhis gujanensis(Aves: Vireonidae)

AbstractCyclarhis gujanensis is a little bird which feeds on high number of large preys, such frogs, lizards, snakes, bats and birds. As there are few studies on the cranial anatomy of this species, we aimed to describe the cranial myology to contribute to the anatomical knowledge of this species and to make some assumptions about functional anatomy. Thus, we described the muscles from the jaw apparatus (external and internal adductor muscles, the muscles of the pterygoid system and the depressor muscles of the mandible). The adductor system is the greatest and multipinulated, particularly in its origin in the caudal portion of the temporal fossa. The depressor jaw muscles systems are enlarged with many components in complexity. The most of jaw apparatus muscles are short, but the strength (biting or crushing forces) from short feeding apparatus fibers probably is increased by high number of components and pinnulation. These anatomical aspects of the muscles indicate a considerable force in the jaws, without which C. gujanensis probably could not cut their prey into smaller pieces. However, functional approaches to analysis of forces of the muscle fibers are needed to corroborate / refute the hypotheses mentioned above.

ResumoO pitiguari (C. gujanensis) é um pássaro neotropical que se alimenta de uma ampla variedade de presas grandes, tais como lagartos, anuros, morcegos e aves. Como são escassos os estudos sobre a anatomia craniana desta espécie, descrevemos a miologia craniana para contribuir com o seu conhecimento anatômico e inferir hipóteses sobre sua anatomia funcional. Foram descritos os músculos adutores mandibulares, externos e internos, do sistema pterigóideo e depressores da mandíbula. O sistema adutor, com a função de elevar a mandíbula, é o mais desenvolvido, particularmente em sua origem na porção caudal da fossa temporal. O músculo depressor da mandíbula possui vários componentes. A maioria dos músculos do aparato mandibular tem tamanho pequeno, porém a ave possui um grande potencial para dilacerar, e essa força provavelmente se deve ao grande número de componentes e pinulações neles presentes. Esses aspectos anatômicos da musculatura indicam uma força considerável nas maxilas, sem a qual C. gujanensis provavelmente não conseguiria cortar suas presas em pedaços menores. No entanto, mais estudos, tanto em abordagens funcionais como análises de forças das fibras musculares, são necessários para corroborar/refutar as hipóteses mencionadas acima.

An in vivo study to correlate the relationship of the extraoral and intraoral anatomical landmarks with the occlusal plane in dentulous subjects.

Background: The occlusal plane position is considered to be the primary link between esthetic and function. Aim: To evaluate the relationship between extraoral and intraoral soft tissue landmarks with the occlusal plane in dentulous subjects on both sides and to check for any variations. Study and Design: An in vivo study and 100 subjects with all healthy permanent teeth in normal arch and alignment were selected from Modern Dental College and Research Centre, Indore. Materials and Methods: Three custom made instruments (occlusal plane analyzer, buccinator groove relator, and level analyzer) were indigenously designed to check parallelism of the interpupillary line, ala‑tragus line, buccinator groove with the occlusal plane. Relation of retromolar pad with the occlusal plane was checked with the metallic scale. Statistical Analysis: Chi‑square test. Results: In 20.0% subjects, the occlusal plane was parallel to the interpupillary line. The posterior reference point for ala‑tragus line was middle point on right side in 56% and left side in 58% subjects. Intraorally, right side 59% and left side 62% subjects had the occlusal plane at the same level as that of buccinator groove. Right side 48% and left side 45% subjects showed occlusal plane at the middle one‑third of retromolar pad. Conclusion: The occlusal plane is not generally parallel to interpupillary line. The occlusal plane is parallel to the ala‑tragus line with middle point of tragus as posterior reference point on right and left sides. Both sides, the buccinator groove and the middle one‑third retromolar pad are coinciding with occlusal plane level.

Semi-longitudinal study of the McNamara cephalometric triangle in Class II and Class III subjects grouped by cervical vertebrae maturation stage

El objetivo del estudio fue comparar los valores del triángulo cefalométrico de McNamara en sujetos normodivergentes no tratados con maloclusión de Clase II y Clase III, de origen latinoamericano, agrupados por estadío de maduración devértebras cervicales, en comparación con un grupo control sin tratamiento, normodivergentes y con maloclusión de Clase I. El estudio se realizó sobre una muestra de seiscientos diez cefalogramas laterales de cabeza pretratamiento (250 hombres, 360 mujeres) que fueron agrupados de acuerdo a su relación esquelética sagital (Clase I, II ó III), estadío de maduración vértebras cervicales (pre pico puberal P1 = CS1 y CS2, pico puberal P2 = CS3 y CS4, y post pico puberal P3 = CS5 y CS6) y sexo. Se midió en cada cefalograma el triángulocefalométrico de McNamara Co-A, Co-Gn y ENA-Me. Se realizaron las pruebas de ANOVA y post-hoc Tukey HSD paradeterminar las diferencias entre grupos. Los resultados en hombres muestran que los mayores aumentos maxilares ymandibulares se produjeron durante la etapa P3 (CS5 para CS6), mientras que en las mujeres se produjeron en la etapaP2 (CS3 para CS4). Las distancias Co-A y Co-Gn muestran diferencias significativas entre las diferentes clases (p <0,05). La longitud maxilar de los sujetos de Clase II y la longitudmandibular de los sujetos de Clase III estuvieron aumentadas al inicio del período evaluado (P1). Se identificó una tendencia al empeoramiento de las maloclusiones de Clase II y III durante el período evaluado. Finalmente los cambios en los valores del triángulo cefalométrico de McNamara fueron marcadamente diferentes en las tres clases de maloclusión en sujetos normodivergentes. En estos sujetos latinoamericanos el estirón puberal se produjo en momentos diferentes con respecto a la raza caucásica y lasnormas asiáticas...

Assessment of cephalometric characteristics in the elderly

This cross-sectional study aimed at assessing the cephalometric characteristics in the elderly, taking into account differences between genders, age ranges, ethnic groups and dental aspects. The sample consisted of 250 elderly subjects of both genders (163 female, mean age: 68 yr.; 87 male: 70.4 yr.). Conventional lateral cephalograms for cephalometric analysis were scanned and analyzed by Dolphin Imaging software 11.5. The statistical treatment of the data evaluated the influence of gender and age range variables (independent ttest), as well as ethnic group, facial profile, and dental characteristics (one-way ANOVA), on cephalometric measurements. A confidence interval of 95% and level of significance of 5% were considered for all the tests performed. The results revealed: 1) The cephalometric measurements evaluated showed significantly lower values for the female gender; 2) a significant decrease in the cephalometric values was observed in relation to the growth pattern, with the advancement of age; 3) significant cephalometric differences were observed between the ethnic groups and the facial profiles; 3) dentulous patients had greater absolute values for all the components evaluated, followed by the individuals with partial dental losses and by those who were edentulous. It may be concluded that the cephalometric alterations observed in this study are inherent to facial maturity, and that they represent specific characteristics regarding each of the variables evaluated. These modifications must be taken into account when planning the treatment for younger patients, to minimize the modifications arising from the natural aging process.

Revisión bibliográfica de la anatomía del nervio dentario inferior y su implicancia en la cirugía implantológica de los sectores posteriores mandibulares / A review of the literature on inferior alveolar nerve anatomy and its involvement with implant surgery of the posterior mandibular sectors

El nervio dentario inferior es una de las estructuras anatómicas más importantes a considerar previo a la colocación de implantes dentales en la mandíbula. La lesión de este nervio es una situación temida por los pacientes y los profesionales por la posibilidad de daño permanente en su conducción nerviosa. Es fundamental para todos los odontólogos que realicen maniobras quirúrgicas próximas a la entidad nerviosa, conocer ampliamente su recorrido, distribución y características normales, para prevenir la injuria del mismo y sus indeseables consecuencias. El objetivo de esta publicación es brindar información actualizada del conocimiento del nervio dentario inferior y su relación con la implantología oral...

Reporte clínico: registro piezográfico de la zona neutra, en un paciente con espasmos musculares involuntarios / Clinical report: piezographyc record of the neutral zone in a complete edentulous patient with involuntary muscle spasms

Toda función del sistema estomatognático involucra la acción sinérgica de la musculatura paraprotética, representada por estructuras complejas tales como lengua, labios, mejillas y piso de boca. Al rehabilitar a través de prótesis completas no siempre se considera la influencia de la dinámica muscular, y menos aún cuando alguna de estas estructuras presenten alguna patología, por ejemplo, el compromiso del nervio facial que genera espasmos musculares involuntarios. En tal situación, la ubicación de los dientes y la forma de las superficies pulidas pueden llegar a ser decisivos entre éxito o fracaso de la rehabilitación. Se sabe que los implantes oseointegrados proveen retención, soporte y estabilidad, sin embargo existen situaciones especiales en que no es posible acceder a este tipo de tratamiento, tanto por razones médico quirúrgicas o costos asociados. En este estudio se ha utilizado un registro Piezográfico de la Zona Neutra en un paciente con compromiso del nervio facial que genera espasmos musculares involuntarios del lado afectado, obteniéndose una rehabilitación protésica basada en la apropiada relación entre superficie protésica externa y tejidos circundantes, mejorando requisitos funcionales tales como retención y estabilidad. Se ha utilizado el sistema de tomografía computarizada Cone Beam, con el objetivo de evidenciar el registro piezográfico. Los resultados obtenidos con estas prótesis piezográficas demuestran ser superior en factores como comodidad y fonoarticulación pero inferior en eficiencia masticatoria comparada con la técnica convencional.

Every function of the stomatognathic system involves the synergistic action of the musculature around the prosthesis, consisting of complex and individual structures such as tongue, lips, cheeks and mouth floor. When planning and making complete prostheses, the muscular dynamic is not always considered. This can generate instability of the device during function, the location of the artificial teeth is made arbitrarily on the top and middle parts of the flange, and the configuration of the polished areas is made according to mechanistic concepts. This factor takes more relevance in patients with severe atrophy of their residual flanges, where the prosthetic stability can be a decisive factor between the success or failure of the rehabilitation. It is known that the osseointegrated implants provide retention, support and stability. However, there are special situations in which it is not possible to access to this type of treatment, both for medical surgical reasons or associated costs. In this study, a Piezographyc record of the Neutral Zone was used in a patient with facial nerve involvement generating involuntary muscle spasms of the affected side. A prosthetic rehabilitation based on the appropriate relation between external prosthetic surface and surrounding tissues was obtained, improving functional requirements such as retention and stability. The computerized tomographic Cone Beam system was used, with the objective to show the piezographic record. The results obtained with these piezographic prostheses prove to be superior in factors like comfort and speech articulation, but inferior in masticatory efficiency, where the conventional technique is still better.

Stability of molar relationship after non-extraction Class II malocclusion treatment

OBJECTIVE: This study aimed to evaluate the stability of molar relationship after non-extraction treatment of Class II malocclusion. METHODS: The sample comprised 39 subjects (16 females, 23 males) with initial Class II malocclusion treated with no extractions, using fixed appliances. Mean age at the beginning of treatment was 12.94 years, at the end of treatment was 15.14 years and at post-retention stage was 21.18 years. Mean treatment time was 2.19 years and mean time of post-treatment evaluation was 6.12 years. To verify the influence of the severity of initial Class II molar relationship in stability of molar relationship, the sample was divided into two groups, one presenting a ½-cusp or ¾-cusp Class II molar relationship, and the other with full-cusp Class II molar relationship. In dental casts from initial, final and postretention stages, molar, first and second premolars and canine relationships were measured. Data obtained were analyzed by dependent ANOVA, Tukey and Pearson's correlation tests, as well as independent t test between the two groups divided by severity of initial molar relationship. RESULTS: There was a non-statistically significant 0.12 mm relapse of molar relationship. The initial severity of Class II molar relationship was not correlated to relapse in the post-retention period. When compared, the two groups showed no difference in relapse of molar relationship. CONCLUSION: It was concluded that correction of Class II molar relationship is stable and initial severity does not influence relapse of molar relationship.

OBJETIVO: esse estudo objetivou avaliar a estabilidade da relação molar na má oclusão de Classe II tratada ortodonticamente sem extrações, visando quantificar a recidiva e correlacioná-la a alguns fatores. MÉTODOS: a amostra constituiu-se de 39 indivíduos (16 mulheres e 23 homens) com má oclusão de Classe II tratada sem extrações, com aparelhos fixos. A idade inicial média foi de 12,94 anos; na fase final, foi de 15,14 anos; na pós-contenção, 21,18 anos. A média do tempo de tratamento foi de 2,19 anos e do tempo de avaliação pós-tratamento, de 6,12 anos. Para verificar a influência da severidade da relação molar de Classe II inicial na estabilidade da relação molar, a amostra foi dividida em dois grupos, um apresentando relação molar de ½ Classe II ou ¾ de Classe II, e outro apresentando relação molar de Classe II completa. Nos modelos de estudo das três fases estudadas, foram medidas a relação molar, as relações de primeiros e segundos pré-molares e de caninos. Os dados foram analisados pelos testes ANOVA dependente, de Tukey, correlação de Pearson e teste t independente entre dois grupos, divididos pela severidade da relação molar inicial. RESULTADOS: houve recidiva não significativa de 0,12mm na relação molar. A severidade inicial da relação molar de Classe II não se correlacionou com a recidiva no período pós-contenção. Quando a amostra dividiu-se em dois grupos, nenhuma diferença foi encontrada na recidiva da relação molar. CONCLUSÃO: a correção da relação molar de Classe II é estável e a severidade inicial não exerce influência sobre a recidiva da relação molar.

Reabilitação total dos maxilares com carga imediata / Full mouth rehabilitation using immediate implant loading

O carregamento moderado e controlado dos implantes suporta e reforça a osteogênese, podendo aumentar a superfície de contato osso-implante. Isto ocorre porque quando as células osteoprogenitoras são expostas a uma deformação física limitada, a sua diferenciação em osteoblastos é melhorada. Neste momento, alguma variação de microtensão é considerada vantajosa para a neoformação óssea assim como para a osseointegração. A estabilidade primária é um dos principais pré-requisitos clínicos para o controle da micromovimentação entre o implante e o tecido de formação interfacial, o que ajuda a determinar o ambiente mecânico adequado para a osteogênese. Com base nos aspectos biológicos do carregamento de implantes imediatos, o objetivo deste estudo é apresentar um caso clínico de reabilitação total dos maxilares com carga imediata. Sete implantes foram colocados na maxila e seis na mandíbula seguindo-se a instalação de duas próteses do tipo protocolo com carga imediata, uma vez que a estabilidade primária foi alcançada para todos os implantes. Instruções sobre a função mastigatória e como ela está relacionada com a micromovimentação dos implantes foram abordadas e enfatizadas para o paciente. A razão por essa opção de tratamento foi de reduzir o tempo de tratamento, devolução de estética e função para o paciente. Após dois anos de acompanhamento clínico, os autores concluíram que a reabilitação maxilomandibular simultânea com carga imediata pode ser indicada e realizada após um planejamento adequado do caso clínico com base na tomografia computadorizada, proporcionando estética e função imediatas para o paciente

Moderate and controlled loading of the implants support or enhance osteogenesis, which may augment the bone-to-implant contact area. This occurs because when osteoprogenitor cells are exposed to limited physical deformation, their differentiation into osteoblasts is enhanced. Then, some range of microstrain is considered advantageous for bone ingrowth and osseointegration. The primary stability has been considered one of the main clinical requisitions for controlling micro motion between the implant and the forming interfacial tissue, which helps to establish the proper mechanical environment for osteogenesis. Based on the biological aspects of immediate implant loading, the objective of this study was to present a clinical case of immediate full mouth rehabilitation. Seven dental implants were placed in the maxilla and six in the mandible followed by the installation of both immediate- -load prosthetic protocols, once primary stability was reached for all implants. In addition, instructions about masticatory function and its relation with interfacial micro motion were addressed and emphasized to the patient. This treatment was chosen aiming at reducing the period of treatment and restore function and aesthetics. After a 2 year follow-up of the rehabilitation, the authors could conclude that simultaneous maxillomandibular rehabilitation with immediate loading can be indicated and performed after a well establish treatment planning based on computed tomography, providing immediate aesthetic and function to the patient

Os benefícios da overdenture maxilar sobre implantes sem cobertura palatina - relato de caso / The benefits of maxillary implant-retained overdenture without palatine cover - case report

A prótese total convencional é o tipo de tratamento mais comum para maxilas edêntulas. No entanto, os pacientes estão buscando melhor qualidade de vida, principalmente no que diz respeito à retenção e a estabilidade quando se trata de rebordos atróficos e, além disso, buscam o conforto proporcionado pela ausência da resina no palato. Esse desenho é possível através da overdenture sem cobertura palatal. O objetivo desse trabalho foi descrever um caso clínico solucionado por meio de uma prótese total maxilar com cobertura parcial de palato. Conclui-se que com o advento dos implantes osseointegrados é possível este desenho protético, e que a quantidade e posição dos implantes é um aspecto de suma importância a ser considerado para o sucesso desta modalidade de reabilitação

The conventional total denture is the most common treatment to edentulous jaws. However, patients are looking for better quality of life, particularly regarding retention and stability in cases of atrophic ridges, and searching for the comfort provided by the absence of resin on the palate. This design is possible through the overdenture without palate coverage. The aim of this study was to describe a clinical case solved usig a maxillary complete denture with partial coverage of palate. It was concluded that, with the advent of osseointegrated implants this prosthetic design is possible, and that the number and position of the implants is a very important aspect to be considered for the success of this type of rehabilitation

Determination of craniofacial relation among the subethnic Indian population: A modified approach - (Sagittal relation).

Aim : To measure the linear cephalometric dimensions of anterior and posterior segments of the craniofacial complex sagittally, to establish ratios between different linear dimensions of sagittal segments and check for dimensional balance among the various segments in subjects with normal occlusion, pleasing profile and facial harmony. Setting and Sample Population : Department of Orthodontics, Saveetha University. Lateral cephalograms of 120 subjects of both sexes in the age group of 17-28 years with normal occlusion belonging to Chennai, India Materials and Methods : Linear dimensions of anterior and posterior segments of the craniofacial complex were measured sagittally with the posterior maxillary plane as a key reference plane. Ratios were established between the various parameters in the anterior and posterior region. Results : A ratio of 1:1 was found to exist between the individual and aggregate sagittal segments of the craniofacial complex in both sexes. There was a statistically significant sexual dimorphism in the aggregate lengths(P=0.028,P=0.005).However, the ratio between the anterior cranial floor and effective maxillary length was 2:3 and 5:8 and that between anterior cranial floor to effective mandibular length was 5:8 and 3:5 in females and males respectively. The difference in the above values was not statistically significant. Conclusion : A dimensional balance was found to exist between the maxilla and mandible both at the dentoalveolar and skeletal level with a ratio of 1:1. There was also a dimensional balance between the posterior cranial floor and ramus width. However, there was no architectural balance between the anterior cranial floor and maxilla and mandible.

Evaluation of divine proportion ratio as a method for registration of rest vertical dimension using statistical analysis in completely edentulous patients

This study aimed to present a reliable way to determine the arbitrary relation using the divine proportion method. The study relied on statistical analysis between different conventional ways to put the patient at rest versus the use of divine proportion method. One hundred completely edentulous patients were selected to determine the correct rest vertical dimension using the divine proportion method versus three other conventional methods which are the lip moisten and the relax, swallowing and phonetics through the letter [M]. There was marked statistical significant difference between the recorded rest vertical dimension between the divine proportion method and the other three conventional methods while on comparing the conventional methods to each other the results showed no statistical significant difference. The results of this study suggested the use of more than one method for determination of rest vertical dimension to assure proper measurement. Since the divine proportion method depends on fixed and unchanged anatomical landmarks occupying the middle third of the face, it should be the method of choice for measuring the rest vertical dimension