Diagnóstico y plan de tratamiento de la Clase II / Diagnosis and treatment planning of Class II

En este artículo se consideran las condiciones que pueden modificar la valoración de la relación esquelética en el diagnóstico de la Clase II: desprogramación a relación céntrica, valoración de la clase esquelética, posición sagital del maxilar y de la mandíbula, el espacio de las vías aéreas, el torque de incisivos superiores e inferiores, la forma de la sínfisis, la interrelación con los planos vertical y transversal, y los caracteres faciales secundarios. A partir de estas conclusiones diagnósticas se desarrolla un plan de tratamiento que es equivalente tanto en casos de dentición mixta como permanente, pero utilizando diferentes aparatologías para conseguir mejores resultados de acuerdo al estado evolutivo de las arcadas dentarias(AU)

In this article, the conditions that can modify the evaluation of skeletal relationship in the diagnosis of Class II malocclusions are considered: deprogramming to centric relation, evaluation of skeletal class, sagittal position of maxilla and mandible, upper airways space, lower and upper incisors torque, shape of the symphysis, interrelationship between vertical and transverse planes, and secondary facial characteristics. From these diagnostic conclusions, a treatment plan is developed, that is similar in both mixed and permanent dentition cases, but using different appliances to get better results according to the evolutionary state of dental arches(AU)

Relación entre oclusión dentaria y postura cráneo-cervical en niños con maloclusiones clase II y III / Relationship between dental occlusion and craniocervical posture in children with class II and III malocclusions

RESUMEN Introducción: la relación entre las maloclusiones y la postura del sistema cráneo cervical ha generado un interés creciente entre los ortodontistas. Objetivo: describir la relación entre la oclusión dentaria y la postura del sistema cráneo-cervical en niños con maloclusiones clase II y clase III. Materiales y métodos: estudio descriptivo transversal. El universo estuvo formado por 19 niños, de 7 a 12 años, con maloclusiones clase II y III de Angle. Ingresados en el Servicio de Ortodoncia de la Facultad de Estomatología de La Habana, en octubre del 2016. Se realizó examen bucal y telerradiografía. Los resultados se presentaron en tablas. Resultados: predominó la clase II de Angle, donde la distoclusión molar fue más marcada en el lado derecho (-2,95 mm) y en la clase III la mesioclusión mayor correspondió al izquierdo (2,25 mm como promedio). En ambas predominó la ½ unidad (36,8 % en clase II). El ángulo cráneo-vertebral y el espacio suboccipital estuvieron dentro del rango normal; 104,65º y 7,99 mm, en clase II y en clase III, 103,78º y 6,90 mm como promedio. La profundidad de la columna cervical fue 6,26 mm y 6,20 mm respectivamente; lo que significó una rectificación de columna cervical. Conclusiones: se encontró más frecuente la clase II de Angle. La posición de la cabeza fue normal en ambas clases y la columna cervical rectificada. Se identificaron relaciones inversas entre la magnitud de la maloclusión con la posición de la cabeza y la columna cervical.

ABSTRACT Introduction: the relationship between malocclusions and the crania-cervical system posture has generated a a growing interest among orthodontists. Objective: to describe the relationship between dental occlusion and the position of the crania-cervical system in children with class II and class III malocclusions. Materials and methods: cross-sectional, descriptive study. The universe was 19 children, aged from 7 to 12 years, class II and III Angle's malocclusions, admitted in the Orthodontics service of the Faculty of Stomatology of Havana in October 2016. Oral examination and teleradiography were performed. The results were presented in tables. Results: Class II of Angle predominated, where the molar distoclusion was more marked on the right side (-2.95 mm) and in class III the greater mesioclusion corresponded to the left (2.25 mm as average). In both, the ½ unit predominated (36.8% in Class II). The cranio-vertebral angle and the suboccipital space were within the normal range; 104.65º and 7.99 mm in class II and in class III 103.78º and 6.90 mm as average. The depth of the cervical spine was 6.26 mm and 6.20 mm respectively; which meant a rectification of the cervical spine. Conclusions: Angle's Class II was found more frequent. The position of the head was normal in both classes and also the rectified cervical spine. Inverse relationships were identified between the magnitude of the malocclusion and the position of the head and cervical spine. The objective of this work is to present a clinical case and the importance of a nurse intervention.

Angle Class II, Division 2 Malocclusion and Association with Late Eruption

Objective: To verify the dental age of individuals with Angle Class II, division 2 malocclusion. Material and Methods: The sample consisted of 200 panoramic radiographs of schoolchildren from the city of Fortaleza in the state of Ceará, in the northeast of Brazil. These radiographs were divided into two groups (N=100): a Control group comprising radiographs of patients with normal occlusion and a CIID2 group comprising radiographs of patients with an Angle Class II, division 2 malocclusion. The Demirjian method was used to identify dental age. All the radiographs were evaluated by a sole duly trained and calibrated technician. The Kappa coefficient for inter-annotator agreement was 0.98 based on the criteria of eruption stage of each tooth. Statistical analysis was performed using the Chi-squared test, Student's t-test and the Mann-Whitney test, with a level of significance of 5%. Results: There was a significant statistical difference between the dental ages of the groups tested. The CIID2 group had a lower dental age than the control group, signifying late eruption in patients with an Angle Class II, division 2 malocclusion. Conclusion: Patients with an Angle Class II, division 2 malocclusion had a lower dental age than patients with normal occlusion, suggesting that orthodontic treatment should be delayed. The first molars, second pre-molars and canines suffered late eruption.

Sensitivity and Specificity of Cephalometric Measures for the Diagnosis of Sagittal Skeletal Malocclusion

Objective: To evaluate and compare sensitivity and specificity of ANB, Wits, APDI and AF-BF to diagnose sagittal skeletal malocclusions, in children between 6 to 12 years old, using ROC curves, a widely accepted method for the analysis and evaluation of diagnostic tests. Material and Methods: A descriptive-comparative study of diagnostic tests was conducted. From a population of 3,000 children, a non-probabilistic sample of 209 was selected. The clinical classification of the patients as class I, II or III, made by a group of experts based on the visual inspection of models and photographs, was chosen as the gold standard. After calibration (ICC>0.94) the variables were measured in cephalograms. Eight ROC curves were plotted (I vs II, and I vs III for each one of the variables). The area under the curve was measured and compared (Ji-square test). Cut points were established. Results: To discriminate Class I from II, ANB showed the largest area under the curve (AUC) (0.876) and the cut point (best sensitivity and specificity) was at 5.75°. To discriminate class I from III, Wits showed the largest AUC (0.874) with a cut point of -3.25 mm. There were no statistical differences between the AUC for the four variables (p=0.48 y p=0.38 for class I-II and I-III). Conclusion: ANB and Wits performed better for the diagnosis of class II and III, respectively. Cut points in children were different from those reported in adults.

Comparing the Clinical Success Rate of Self-Drilling and Self-Tapping Mini-screws in the Retraction of Maxillary Anterior Teeth

Objective: To compare the success of self-drilling and self-tapping methods in the retraction of maxillary anterior teeth. Material and Methods: The study was conducted in 57 subjects with Cl II malocclusion who needed to be treated with extraction of four maxillary teeth. The selftapping method was used on the left side and the self-drilling method was used on the right side. Then, the pain rate of each method was recorded by the numerical rating scale (NRS). Statistical analysis was done by t-test and Chi-square test. The significance level in this study was considered at p-value<0.05. Results: Considering the clinical mobility as the failure, the success of treatment was equal in both methods and was 93%. The inflammation around the mini-screws was 8.8%. A significant relationship was found between the variables inflammation and success (p<0.05). The mean pain was 2.47 but there was no significant difference between the two methods in terms of pain score (p>0.05). There was a significant difference between the groups (p=0.03). The pain was significantly higher in the female. Conclusion: There is no difference between self-drilling and self-tapping methods in terms of success. Comparison of the pain between two genders according to the replantation method showed a significant difference in pain sensation between two genders. The pain sensation mean in female group was greater than male group.

Diagnostic validity of different cephalometric analyses for assessment of the sagittal skeletal pattern

Abstract Introduction: Numerous cephalometric analyses have been proposed to diagnose the sagittal discrepancy of the craniofacial structures. Objective: This study aimed at evaluating the reliability and validity of different skeletal analyses for the identification of sagittal skeletal pattern. Methods: A total of 146 subjects (males = 77; females = 69; mean age = 23.6 ± 4.6 years) were included. The ANB angle, Wits appraisal, Beta angle, AB plane angle, Downs angle of convexity and W angle were used to assess the anteroposterior skeletal pattern on lateral cephalograms. The sample was classified into Class I, II and III groups as determined by the diagnostic results of majority of the parameters. The validity and reliability of the aforementioned analyses were determined using Kappa statistics, sensitivity and positive predictive value (PPV). Results: A substantial agreement was present between ANB angle and the diagnosis made by the final group (k = 0.802). In the Class I group, Downs angle of convexity showed the highest sensitivity (0.968), whereas ANB showed the highest PPV (0.910). In the Class II group, ANB angle showed the highest sensitivity (0.928) and PPV (0.951). In the Class III group, the ANB angle, the Wits appraisal and the Beta angle showed the highest sensitivity (0.902), whereas the Downs angle of convexity and the ANB angle showed the highest PPV (1.00). Conclusion: The ANB angle was found to be the most valid and reliable indicator in all sagittal groups. Downs angle of convexity, Wits appraisal and Beta angle may be used as valid indicators to assess the Class III sagittal pattern.

Resumo Introdução: numerosas análises cefalométricas foram propostas para diagnosticar a discrepância sagital das estruturas craniofaciais. Objetivo: este estudo teve como objetivo avaliar a confiabilidade e validade de diferentes análises esqueléticas para a identificação do padrão esquelético sagital. Métodos: foram incluídos 146 indivíduos (homens = 77; mulheres = 69; idade média = 23,6 ± 4,6 anos). O ângulo ANB, a avaliação de Wits, o ângulo Beta, o ângulo do plano AB, o ângulo de convexidade de Downs e o ângulo W foram utilizados para avaliar o padrão esquelético anteroposterior em cefalogramas laterais. A amostra foi classificada nos grupos Classe I, II e III, conforme os resultados diagnósticos da maioria dos parâmetros. A validade e a confiabilidade das análises acima mencionadas foram determinadas usando estatísticas Kappa, sensibilidade e valor preditivo positivo (VPP). Resultados: foi encontrada uma concordância significativa entre o ângulo ANB e o diagnóstico feito pelo grupo final (k = 0,802). No grupo Classe I, o ângulo de convexidade de Downs mostrou a maior sensibilidade (0,968), enquanto o ANB apresentou o maior VPP (0,910). No grupo Classe II, o ângulo ANB mostrou a maior sensibilidade (0,928) e o maior VPP (0,951). No grupo Classe III, o ângulo ANB, a avaliação de Wits e o ângulo Beta apresentaram a maior sensibilidade (0,902), enquanto o ângulo de convexidade de Downs e o ângulo ANB apresentaram o maior VPP (1,00). Conclusão: o ângulo ANB foi considerado o indicador mais válido e confiável em todos os grupos sagitais. O ângulo de convexidade de Downs, a avaliação de Wits e o ângulo Beta podem ser usados como indicadores válidos para avaliar o padrão sagital de Classe III.

Class II malocclusion with accentuated occlusal plane inclination corrected with miniplate: a case report

ABSTRACT Introduction: A canted occlusal plane presents an unesthetic element of the smile. The correction of this asymmetry has been typically considered difficult by orthodontists, as it requires complex mechanics and may sometimes even require orthognathic surgery. Objective: This paper outlines the case of a 29-year-old woman with Class II malocclusion, pronounced midline deviation and accentuated occlusal plane inclination caused by mandibular deciduous molar ankylosis. Methods: The patient was treated with a miniplate used to provide anchorage in order to intrude maxillary teeth and extrude mandibular teeth on one side, thus eliminating asymmetry. Class II was corrected on the left side by means of distalization, anchored in the miniplate as well. On the right side, maxillary first premolar was extracted and molar relationship was kept in Class II, while canines were moved to Class I relationship. The patient received implant-prosthetic rehabilitation for maxillary left lateral incisor and mandibular left second premolar. Results: At the end of treatment, Class II was corrected, midlines were matched and the canted occlusal plane was totally corrected, thereby improving smile function and esthetics.

RESUMO Introdução: o plano oclusal inclinado representa um elemento antiestético para o sorriso. A correção dessa assimetria é normalmente considerada difícil pelos ortodontistas, requerendo mecânica complexa e, algumas vezes, até cirurgia ortognática. Objetivo: esse artigo descreve o caso de uma paciente de 29 anos, portadora de má oclusão de Classe II, com considerável desvio das linhas médias e acentuada inclinação do plano oclusal, causada pela anquilose de molar decíduo inferior. Métodos: a paciente foi tratada com ancoragem em miniplaca, para promover a intrusão dos dentes superiores e extrusão dos dentes inferiores em um lado, eliminando a assimetria. A Classe II foi corrigida no lado esquerdo por meio de distalização, também ancorada na miniplaca. No lado direito, o primeiro pré-molar superior foi extraído e a relação de molares de Classe II foi mantida, enquanto os caninos foram movidos para relação de Classe I. A paciente recebeu reabilitação por meio de implante e prótese no incisivo lateral superior esquerdo e no segundo pré-molar inferior esquerdo. Resultados: ao término do tratamento, a Classe II foi corrigida, as linhas médias estavam coincidentes e a inclinação do plano oclusal foi totalmente corrigida, melhorando consideravelmente os aspectos funcionais e estéticos da oclusão.

Influence of Facial and Occlusal Characteristics on Gummy Smile in Children: A Case-Control Study

Objective: To determine the association between occlusal and soft tissue characteristics with the presence of gingival smile (GS) in a pediatric population with inter-transitional mixed dentition. Material and Methods: Case-control study was performed with a probabilistic sample of 163 children in inter-transitional mixed dentition (age:8.8 years ±0.8). Cases were 37 children with GS, and controls were 126 children without GS. Occlusal variables were assessed through clinical examination, and soft tissue variables were assessed through photograms. Kappa test and intraclass correlation coefficient were done (0.87-0.96). The association between malocclusion, gender, and types of smile was assessed using a Chi square test. Comparison of quantitative variables in smile groups was made by Student t test. A multivariate binary logistic regression was performed. Results: Class II malocclusion, short upper lip at smile and short incisor clinical crown, were risk factors for gummy smile (OR= 10.4, 95%CI 3.07- 34.95, OR= 2.1, 95%CI 1.44- 3.13 and OR= 2.5 95%CI 1.34- 4.54 respectively). Lower facial height was a protective factor against GS (OR= 0.76; 95%CI 0.69- 0.85). The logistic regression model explains 48% of GS variability. Conclusion: Class II malocclusion is considered a risk factor for gummy smile. Other variables associated to gummy smile were short upper lip and short incisor clinical crown. Clinicians should considered these aspects in clinical examination of each patient to provide an adequate diagnostic and plan of treatment to control and/or correct a GS.

Un tratamiento antiguo y vigente en ortodoncia: expansión rápida maxilar / An old and current orthodontic treatment: rapid maxillary expansion

Las anomalías transversales se presentan frecuentemente desde edades tempranas. Generalmente son causadas por problemas funcionales como deglución atípica y respiración bucal. Las alteraciones de la oclusión sobre el plano transversal son conocidas como mordidas cruzadas posteriores, pudiendo ser de origen dentario o esqueletal. Si el diagnóstico de nuestro paciente es una compresión maxilar de origen esqueletal, el tratamiento indicado será la expansión rápida del maxilar (ERM). La corrección de la deficiencia transversal del maxilar superior con el uso del disyuntor, constituye un recurso terapéutico capaz de cambiar las relaciones dentarias y esqueléticas en una primera fase del tratamiento, utilizando al máximo los cambios dinámicos asociados con el crecimiento y preparando un mejor entorno orofacial para la erupción de la dentición permanente. En este trabajo se desarrollan tres casos clínicos que modificaron notoriamente su morfología luego del tratamiento con ERM mediante el uso de diferentes tipos de disyuntores...

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...

Photographic assessment of hyperdivergent skeletal Class II patients / Avaliação fotográfica de pacientes padrão esquelético classe II hiperdivergentes

Desordens temporomandibulares, distúrbios do sono por obstrução das vias aéreas e alterações na postura crânio cervical constituem alguns dos problemas que têm sido relacionados com o paciente padrão esquelético classe II hiperdivergente. Embora as telerradiografias laterais representem o padrão ouro para o diagnóstico da morfologia cranio facial na prática clínica, este exame pode não ser viável para aplicação em estudos epidemiológicos de larga escala. Objetivo: O objetivo deste estudo foi testar a validade de um novo método fotográfico no diagnóstico de pacientes classe II hiperdivergentes para fins de investigação epidemiológica. Material e Métodos: Telerradiografias laterais e fotografias de perfil foram obtidas a partir de 123 indivíduos distribuídos em dois grupos: 51 pacientes compuseram o grupo de pacientes classe II hiperdivergente, enquanto que os outros 72 pacientes formaram um segundo grupo. A análise discriminante descreveu um modelo matemático para melhor diagnosticar pacientes padrão esquelético classe II hiperdivergente através de fotografias. Resultados: Uma função canônica discriminante composta por duas variáveis fotográficas classificou corretamente 85% dos pacientes classe II hiperdivergentes durante a validação interna (p < 0,001). O método mostrou 83% de sensibilidade e 73% de especificidade no processo de validação externa. Conclusão: O método fotográfico pode ser considerado como uma alternativa viável e prática para diagnosticar o paciente classe II hiperdivergente, particularmente se existir a necessidade de um método não invasivo e de baixo custo.

Temporomandibular disorders, sleep disturbances by airway obstruction and craniocervical posture changes constitute some of the problems that have been related to hyperdivergent skeletal Class II patients. Although cephalometric radiographs represent the gold standard for diagnosing craniofacial morphology in clinical practice, it might not be feasible for large-scale epidemiological research. Objectives: The aim of this study was to test the validity of a new photographic method in diagnosing hyperdivergent skeletal Class II patients for epidemiological research purposes. Material and Methods: Lateral cephalograms and profile photographs were obtained from 123 subjects assigned into two groups. 51 patients comprised the hyperdivergent skeletal Class II group and the other 72 composed a second group. Discriminant analysis described a mathematical model to better diagnose hyperdivergent skeletal Class II patients through photographs. Results: A canonical discriminant function composed of two photographic variables correctly classified 85% of the hyperdivergent skeletal Class II patients during internal validation (p < 0.001). The method showed 83% sensitivity and 73% specificity in external validation procedure. Conclusion: The photographic method may be a feasible and practical alternative for diagnosing the hyperdivergent skeletal Class II patient, particularly if there is a need for a low-cost and noninvasive method.

O ativador combinado à ancoragem extrabucal no tratamento da má-oclusão de Classe II / Combination headgear activator for treatment of class II malocclusion

A má-oclusão de Classe II caracteriza-se por uma relaçãoincorreta entre os arcos superior e inferior, e pela discrepância maxilomandibularresultante de protrusão maxilar, retrusão mandibular ouambos, ou ainda pela combinação destes fatores. Esta má-oclusão nãopossui uma morfologia única que a defina, e pode apresentar diversasvariações, tornando complexos seu diagnóstico e tratamento. O corretodiagnóstico é o elemento fundamental para a determinação do planode tratamento e da mecânica a ser empregada. Durante a fase decrescimento, pode-se aplicar uma terapia com aparelhos ortopédicospara o tratamento das más-oclusões de Classe II. Com o potencial decrescimento presente, os aparelhos ortopédicos promovem o redirecionamentodo crescimento das bases apicais objetivando correçãodas discrepâncias anteroposteriores, verticais e transversais. Estamecânica requer máxima colaboração do paciente, entretanto, outrosfatores devem ser considerados para o bom prognóstico do tratamento,como a idade do paciente, o padrão de crescimento e a severidade damá-oclusão. Este artigo, por meio de um relato de caso clínico, visadetalhar os efeitos ortopédicos e ortodônticos no complexo craniofacial,no tratamento da má-oclusão de Classe II esquelética com o usodo ativador combinado à ancoragem extra bucal.

Class II malocclusion is characterized by an incorrectrelationship between the maxilla and the mandible, and by the jawdiscrepancy resulting from maxillary protrusion, mandibular retrusionor both, or by a combination of these factors. This malocclusion doesnot have a unique morphology that defines it. It may present severalvariations, which makes diagnosis and treatment complex. Properdiagnosis is the key element in determining the treatment plan andmechanics to be employed. Orthopedic therapy for the treatmentof Class II malocclusions can be applied during the growth phase.With the potential for growth present, orthopedic appliances promotethe redirection of growth of the apical bases aimed at correctinganteroposterior, vertical and transverse discrepancies. This mechanismrequires maximum cooperation on behalf of the patient. Other factorsthat must be considered as for good treatment outcomes include thepatient's age, growth pattern and severity of mafocclusion. The aim ofthis study is to detail, by a clinical case report, the orthodontic andorthopedic effects on the craniofacial complex of Class II malocclusiontreated using a skefetal activator combined with anchoring headgear.

Bolton ratio in subjects with normal occlusion and malocclusion

AIM: To verify the presence of Bolton anterior and total discrepancy in Brazilian individuals with natural normal occlusion and Angle's Class I and Class II, division 1 malocclusions. METHODS: The sample was divided in three groups (n=35 each): natural normal occlusion; Class I malocclusion; Class II, division 1 malocclusion. Of the 105 Caucasian Brazilian individuals, 24 were boys and 81 were girls aged from 13 to 17 years and 4 months. The mesiodistal width of the maxillary and mandibular teeth, from the left first molar to the right first molar, was measured on each pre-treatment dental plaster cast using a digital caliper accurate to 0.01 mm resolution. Values were tabulated and the Bolton ratio was applied. The Kolmogorov-Smirnov test was used to verify if data were normally distributed (p>0.2). For comparison between the values obtained and those from the Bolton standard, Student's t test was used and one-way ANOVA was used for comparisons among the 3 groups, with a significance level of 5% (p<0.05). RESULTS: For groups 1, 2 and 3, respectively, the total ratio found was 90.36% (SD 1.70), 91.17% (SD±2.58) and 90.76% (SD±2.45); and the anterior ratio was 77.73% (SD 2.39), 78.01% (SD 2.66) and 77.30% (SD 2.65). CONCLUSIONS: There was no significant difference among the groups regarding the values indicated in the Bolton ratio.

Cephalometric evaluation of the predictability of bimaxillary surgical-orthodontic treatment outcomes in long face pattern patients: a retrospective study

OBJECTIVE: The aim of this study was to compare by means of McNamara as well as Legan and Burstone's cephalometric analyses, both manual and digitized (by Dentofacial Planner Plus and Dolphin Image software) prediction tracings to post-surgical results. METHODS: Pre and post-surgical teleradiographs (6 months) of 25 long face patients subjected to combined orthognathic surgery were selected. Manual and computerized prediction tracings of each patient were performed and cephalometrically compared to post-surgical outcomes. This protocol was repeated in order to evaluate the method error and statistical evaluation was conducted by means of analysis of variance and Tukey's test. RESULTS: A higher frequency of cephalometric variables, which were not statistically different from the actual post-surgical results for the manual method, was observed. It was followed by DFPlus and Dolphin software; in which similar cephalometric values for most variables were observed. CONCLUSION: It was concluded that the manual method seemed more reliable, although the predictability of the evaluated methods (computerized and manual) proved to be reasonably satisfactory and similar.

OBJETIVOS: a proposta desse trabalho foi comparar, por meio das análises cefalométricas de McNamara, Legan e Burstone, os traçados de previsão manuais e os digitalizados pelos programas Dentofacial Planner Plus e Dolphin Imaging, com os resultados pós-cirúrgicos. MÉTODOS: foram selecionadas as telerradiografias pré- e pós-cirúrgicas (seis meses) de 25 pacientes face longa submetidos a cirurgia ortognática combinada. Foram realizados os traçados de previsão manual e computadorizados de cada paciente, comparando-os, cefalometricamente, com os resultados pós-cirúrgicos. Esse protocolo foi repetido para avaliação do erro do método e realizou-se a avaliação estatística por meio da análise de variância e sobreteste de Tukey. RESULTADOS: observou-se uma maior frequência de variáveis cefalométricas que não diferiram estatisticamente do resultado pós-cirúrgico real para o método manual, seguido dos programas DFPLus e Dolphin; observando-se valores cefalométricos similares para a maioria das variáveis. CONCLUSÃO: concluiu-se que o método manual pareceu mais fidedigno, embora a previsibilidade dos métodos avaliados (computadorizados e manual) tenha se mostrado razoavelmente satisfatória e similar.

Tratamento da má oclusão de Classe II subdivisão com distalização assimétrica de molares superiores / Treatment od Class II malocclusion, subdivision with asymmetric distalization of upper molars

A má oclusão de Classe II é caracterizada pela posição distal da arcada inferior em relação à superior, com o centro da cúspide mesiovestibular do primeiro molar permanente superior ocluindo mesialmente ao sulco vestibular do primeiro molar permanente inferior. Sua origem pode ser esquelética, dentária ou uma combinação dos dois fatores. Essa má oclusão é dividida em divisão 1 e 2 e pode apresentar subdivisão. A Classe II subdivisão é encontrada em, aproximadamente, 50% dos casos de classe II de Angle, e é caracterizada pela distoclusão de somente um lado da arcada dentária, com o outro em relação de Classe I de molar. O diagnóstico dessa má oclusão deve ser criterioso para a elaboração de plano de tratamento adequado. Diante de uma má oclusão de Classe II subdivisão, deve-se verificar se a assimetria é dentária ou esquelética, e, quando dentária, se está localizada na arcada inferior ou superior. O tratamento das más oclusões de Classe II subdivisão é abrangente e pode envolver extrações, distalizações ou stripping - dependendo da idade do paciente, do tipo das características da má oclusão. Um dos fatores mais importantes no tratamento da Classe II subdivisão, além de finalizar com os caninos em chave de oclusão, é coincidir as linhas médias dentárias entre si, e elas com a linha média facial. O objetivo desse trabalho foi abordar as principais características da má oclusão de Classe II subdivisão com ênfase no diagnóstico e tratamento, e ilustrá-lo com o relato de dois casos clínicos.

Veracidad del ángulo ANB de Steiner en pacientes con clase II esqueletal, comparándolo con el análisis de Wits / Veracity of the Steiner´s ANB angle in patients with skeletal class II, compared with the Wits analysis

El objetivo de este estudio fue eterminar la veracidad del ángulo ANB en pacientes con clase II esqueletal, comparando este ángulo con el análisis de Wits. El trabajo se llevó a cabo sobre una población de 201 individuos de ambos sexos con dentición permanente y mixta, que asistieron al posgrado de la carrera de especialización de Ortodoncia de la Facultad de Odontología de La Plata, a quienes se les tomaron teleradiografías laterales de cráneo en oclusión habitual, sobre las cuales se realizaron cálculos y trazados cefalométricos. Se evaluaron el ángulo ANB de Steiner, donde se determinó la relación sagital de la base apical y del análisis de Wits, donde se determinó la relación maxilomandibular en el plano sagital. Los resultados obtenidos demostraron que no hay una coincidencia en el diagnóstico entre el ángulo ANB y la medición lineal de Wits.

Diagnóstico diferencial e abordagens terapêuticas no manejo / Differential diagnosis and therapeutic approaches in the

O manejo da má-oclusão de Classe II, subdivisão, pode ser um desafio devido ao seu caráter etiológico multifatorial, onde o erro no diagnóstico implicaria em equívocos, entre eles um longo tempo de tratamento. O diagnóstico diferencial é a chave para estabelecer um planejamento ortodôntico efetivo, considerando que a classificação de Angle não permite especificidade, podendo abrigar em uma mesma nomenclatura variados desvios morfológicos dentofaciais. Esta revisão objetivou descrever as características morfológicas, bem como estabelecer parâmetros de diagnóstico diferencial para que o clínico tenha maior segurança em avaliar, prognosticar e conduzir o tratamento da má-oclusão de Classe II, subdivisão. Pouco tem sido descrito a respeito dos aspectos faciais dos pacientes portadores da má-oclusão de Classe II, subdivisão, contrastando com a quantidade de informações encontradas na literatura sobre as características dentoalveolares, radiográficas e tomográficas. Quanto à natureza, a Classe II, subdivisão, é predominantemente dentoalveolar; quanto à localização, o problema se encontra primariamente no arco inferior e, secundariamente, no arco superior. As decisões terapêuticas podem envolver extrações ou não e, em casos extremos, procedimentos ortocirúrgicos, as quais devem basear-se, para o planejamento, nas características da face, relação labial, localização, magnitude do erro e gravidade do apinhamento.

The management of Class II, subdivision malocclusion may be a challenge due to its multifactor etiology feature, where the misdiagnosis would imply in misconceptions, including a long time of treatment. The differential diagnosis is the crucial key to establish an effective orthodontic treatment planning, bearing in mind that Angle’s classification show little specificity, which may cover a range of dentofacial morphological deviations under same nomenclature. This review aimed to describe the morphological characteristics as well as to establish the parameters of differential diagnosis, so that the clinician would have more assurance in evaluating, prognosticating and conducting the treatment of the Class II, subdivision malocclusion. Scarce information related to facial features of Class II, subdivision malocclusion individuals can be found in the literature in contrast to the amount of information with regard to the dentoalveolar, radiographic and tomographic characteristics. In relation to its nature and localization, Class II, subdivision is predominantly dentoalveolar, primarily located at the lower arch and, secondly, at the upper arch. The therapeutic decisions may involve extraction or nonextraction and, in the extreme cases, ortho-surgical procedures, which should be made on the basis of the features of facial pattern, lips relationship, the localization and the magnitude of Class II and the severity of dental crowding.

Conhecimentos e meios necessários para a melhor correção de más-oclusões dentárias e dentoesqueléticas / Necessary knowledge and methods to improve dental and dentoskeletal malocclusion corrections

A correção das desarmonias dentoesqueléticas e neuromusculares mostra-se frequente em nossa especialidade. Sendo assim, cabe ao ortodontista propiciar a melhor forma, função e estabilidade dos seus casos. Embora exista apenas um único diagnóstico para cada caso, o tratamento da má-oclusão deverá ser planejado e executado de forma individualizada, selecionando dentre os vários meios e métodos corretivos a opção que melhor se aplica ao paciente. Neste artigo, pretende-se demonstrar, por meio da apresentação de quatro casos clínicos, alguns protocolos eficientes de tratamentos ortodônticos e ortopédicos que podem ser adotados atualmente para o tratamento de diferentes más-oclusões.

The correction of dentoskeletal and neuromuscular disharmonies occurs frequently in our specialty. In this situation, the orthodontists must provide the best form, function and stability of their cases. Although there is only one diagnosis for each patient, the individualized treatment of malocclusion will be planned and executed by selecting from among various protocols and corrective methods the best one for the patient. In this article, we intended to demonstrate, through the presentation of four clinical cases, some efficient protocols for orthopedic and orthodontic treatments that may be currently adopted for the treatment of different malocclusions.

Tratamiento de la clase II en dentición mixta con la técnica CSW / Treatment of Class II in mixed dentition with the CSW technique

En el presente artículo se analiza el tratamiento temprano de las maloclusiones de clase II esquelética en dentición mixta, relacionando el tratamiento con el diagnóstico realizado.

Tratamiento de la clase II en dentición permanente con la técnica CSW / Class II treatment in permanent dentition with the CSW technique

En los artículos anteriores trabajamos: 1- manejo del perfil de la clase II esquelética con la técnica CSW (Custom-made Straight Wire). Se expuso la importancia del diagnóstico y de la planificación del tratamiento de ortodoncia. 2- En “Tratamiento de la clase II en dentición mixta con la técnica CSW (Custom-made Straight Wire)”analizamos el tratamiento temprano de la clase II. En el presente artículo se analiza el tratamiento de la clase II en dentición permanente, relacionando eltratamiento con el diagnóstico realizado.