Accuracy Assessment of Virtual Surgical Planning Comparing 3D Virtual Surgical Planning and Post-Operative CBCTs in Surgical Skeletal Class III Cases: A Retrospective Study

ABSTRACT Objective: To evaluate the accuracy of Virtual Surgical Planning (VSP) comparing VSPs and post-operative CBCT scans in patients undergoing bimaxillary orthognathic surgery of severe Skeletal Class III malocclusion. Material and Methods: Twenty-three patients (9 males and 14 females, mean age 24.1 ± 7.0 years) were selected and submitted to bimaxillary orthognathic surgery. Pre-operative VSPs and post-operative CBCTs were compared using both linear (taking into account four skeletal and six dental landmarks, each one described by the respective coordinates) and angular measures (seven planes in total). The threshold discrepancies for post-operative clinical acceptable results were set at ≤2 mm for liner and ≤4° for angular discrepancies. The mean difference values and its 95% confidence interval were identified, comparing which planned and which obtained in absolute value. Results: There were significant statistical differences for all absolute linear measures investigated, although only two overcome the linear threshold value of 2mm in both X and Y-linear dimensions. Linear deviations in Z-linear dimension do not reach statistical significance. All 12 angular measures reach the statistical significance, although none overcome the threshold angular value of 4°. Angular deviation for roll register the higher accuracy in contrast to pitch and yaw. Conclusion: Virtual surgical planning is a reliable planning method to be used in orthognathic surgery field; as a matter of fact, although some discrepancies between the planned on the obtained are evident, most of them meet the tolerability range.

Morphological changes of frankel functional regulator III in mixed dentition with class III malocclusion / Cambios morfológicos del regulador funcional frankel III en dentición mixta con maloclusión clase III

The aim of this study was to evaluate the hard and soft tissue profile changes following treatment of functional and mild skeletal class III malocclusion in mixed dentition by means of the Frankel functional regulator (FR-3) appliance, and to reveal the mechanism and effectiveness of treatment with FR-3 appliance. Twenty-six patients (chronological mean age, 8.7±1.4 years; mean treatment duration, 10.3±1.3 months) with functional and mild skeletal class III malocclusion were selected and treated with FR-3 appliances. Lateral cephalogram was taken pre- and post-treatment, and the data was analyzed by paired-samples t test with SPSS22.0 software package. Differences were considered statistically significant at P < 0.05. The results demonstrated that the FR-3 appliance produced a statistically significant decrease in L1-NB, L1-MP, U1-L1 (P<0.01) and an increase greatly in ANB, MP-FH, Y axis, ANSMe, ANS-Me/N-Me and overjet (P<0.01). SNA, SNB were increased significantly (P<0.05). Meanwhile, N'-Sn-Pog', ULSn-SN, LLSiSN increased, S-N'-Si, LL-EP decreased with significant difference (P<0.01). S-N'-Sn, Cm-Sn-UL, UL-EP, Sn-Mes and Ns-Mes increased with significant difference (P<0.05). Therefore it was concluded that after FR-3 treatment, the position of mandible may rotate clockwise backwards and downwards, with the labioversion of upper incisors and linguoversion of lower incisors. Although point A moved mesially, the length and position of the maxilla did not change significantly. With the protrusion of upper lip and the retrusion of lower lip, the relationship among nose, upper lip, lower lip and chin become harmonious, the profile of soft tissue is more coordinated and attractive.

El objetivo de este estudio fue evaluar los cambios en el perfil de los tejidos duros y blandos después del tratamiento de la maloclusión funcional y leve de la clase III esquelética en la dentición mixta mediante el aparato regulador funcional Frankel (FR-3), y revelar el mecanismo y efectividad del tratamiento con el aparato FR-3. Veintiseis pacientes (edad media 8,7 ± 1,4 años; duración media del tratamiento, 10,3 ± 1,3 meses) con maloclusión funcional y leve de clase esquelética III fueron seleccionados y tratados con aparatos FR-3. El cefalograma lateral se tomó antes y después del tratamiento, y los datos se analizaron mediante la prueba t de muestras con el software SPSS22.0. Las diferencias se consideraron estadísticamente significativas a P <0,05. Los resultados demostraron que el dispositivo FR-3 produjo una disminución estadísticamente significativa en L1-NB, L1MP, U1-L1 (P <0,01) y un gran aumento en ANB, MP-FH, eje Y, ANS-Me, ANS -Me / N-Me y overjet (P <0,01). SNA, SNB se incrementaron significativamente (P <0,05). Mientras tanto, N'Sn-Pog', ULSn-SN, LLSi-SN aumentaron, S-N'-Si, LL-EP disminuyeron con una diferencia significativa (P <0,01). S-N'-Sn, Cm-Sn-UL, UL-EP, Sn-Mes y Ns-Mes aumentaron con una diferencia significativa (P <0,05). Por lo tanto, se concluyó que después del tratamiento con FR-3, la posición de la mandíbula puede girar en sentido reloj hacia atrás y hacia abajo, con labioversión de los incisivos superiores y linguoversión de los incisivos inferiores. Aunque el punto A se movió mesialmente, la longitud y la posición del maxilar no cambiaron significativamente. Con la protuberancia del labio superior y la retrusión del labio inferior, la relación entre la nariz, el labio superior, el labio inferior y el mentón se armoniza, el perfil del tejido blando es más coordinado y atractivo.

Developmental association of palatal dimensions and palatal rugae characteristics in Angle´s classes I, II and III of malocclusion / Asociación de desarrollo de las dimensiones palatinas y las características de las rugas palatinas en las clases I, II y III de maloclusión de Angle

During development, bony changes in the palate are reflected in the palatal rugae. Therefore, we hypothesized that the palatal dimensions (PD) influence the shape and number of palatal rugae (PR). The objectives were to record the palatal rugae characteristics (PRC) and palatal dimensions (intercanine distance (ICD), intermolar distance (IMD), palatal height (PH) and palatal area (PA) in Classes I, II and III malocclusion patients and investigate their interrelationship, and statistically examine the possibility of predicting PRC with the PD. Four hundred eighty-one pre-orthodontic study casts of healthy patients with normal palate anatomy were grouped as Classes I, II and III and scanned using 3D cast scanner. The PRC, ICD, IMD, PH, and PA were recorded digitally using 3D enabled software. The data was statistically analyzed. A strong statistically significant difference was observed between PA and number of straight and wavy rugae. ICD and the number of straight rugae were also related. A weak correlation exists between malocclusion classes and PA. The remaining rugae characteristics did not exhibit any relation with palatal dimensions. PA is positively related to the number of straight rugae and negatively related to the number of wavy rugae. Bigger palates have more straight rugae and less number of wavy rugae. A weak correlation between PA and Angle's class I malocclusion exists. We also propose that PA has a developmental association with the number and shape of PR.

Durante el desarrollo, los cambios óseos en el paladar se reflejan en las rugas palatinas. Por lo tanto, planteamos la hipótesis de que las dimensiones palatinas influyen en la forma y el número de las rugas palatinas. Los objetivos fueron registrar las características de las rugas palatinas y las dimensiones palatales (distancia intercanina, distancia intermolar, altura palatina y área palatina) en pacientes con maloclusión de clases I, II y III e investigar su interrelación, y examinar estadísticamente la posibilidad de predecir las características de las rugas palatinas con las dimensiones palatinas. Cuatrocientos ochenta y un estudios pre-ortodónticos de pacientes sanos con anatomía normal del paladar se agruparon como Clases I, II y III y se escanearon con un escáner de emisión 3D. La distancia intercanina, distancia inter molar, altura palatina y área palatina se registraron digitalmente utilizando el software 3D. Los datos se analizaron estadísticamente. Se observó una diferencia estadísticamente significativa entre la altura palatina y el número de rugas rectas y onduladas. Se registró también la distancia intercanina y el número de rugas rectas. Existe una correlación débil entre las clases de maloclusión y la altura palatina. Las características restantes de las rugas palatinas no mostraron ninguna relación con las dimensiones palatinas. El área palatina está relacionada positivamente con el número de rugas rectas y negativamente relacionada con el número de rugas onduladas. Los paladares más grandes tienen más rugas rectas y menor cantidad de rugas onduladas. Existe una correlación débil entre el área palatina y la clase I de maloclusión de Angle. También proponemos que el área palatina tiene una asociación de desarrollo con el número y la forma de rugas palatinas.

Morphological changes of skeletal class III malocclusion in mixed dentition with protraction combined activities / Cambios morfológicos en maloclusión de la clase esquelética III en dentición mixta con actividades combinadas de protracción

The objective of the study was to investigate the morphological changes of skeletal class III malocclusion in mixed dentition with light force protraction combined activities. Randomly selected 30 cases of orthodontics in Shanxi Medical University orthodontics patients (ages: 6-10 years) of the lateral cephalograms. Using the oral maxillary casting type of pre-traction device, according to the condition of maxillary dentition to select the corresponding activities of the movable expansion appliance, each side of the force of about 150-200 g, requiring patients to wear 10-12 hours a day, the appliance should be removed after reaching normal occlusion. The correlation cephalometric profile of the cranial lateral radiographs before and after orthodontic treatment was measured. All patients with skeletal class III malocclusion were improved, concave type became direct type, measurements SNA, ANB, A-Ptm, MP-SN, ANS-Me/N-Me increased, maxillary advancement and reconstruction are more obvious; mandible rotates clockwise; the increase of lip inclination of anterior teeth compensatory changes, lower anterior tooth inclination changes smaller; upper lip forward, nasolabial angle decreased, improved appearance significantly. Light force protraction combined activities can make the mixed dentition of skeletal class III malocclusion in patients with significant improvement in profile appearance.

El objetivo de este estudio fue investigar los cambios morfológicos de la maloclusión clase esquelética III, en la dentición mixta, con actividades combinadas de protracción de la fuerza ligera. Se seleccionaron aleatoriamente 30 casos de ortodoncia en pacientes de ortodoncia de la Universidad Médica de Shanxi (edades: 6-10 años) a partir de cefalogramas laterales, utilizando el tipo de dispositivo de pretracción de vaciado maxilar oral, de acuerdo con la condición de la dentición maxilar para seleccionar las actividades correspondientes del dispositivo de expansión móvil, cada lado con fuerza de alrededor de 150-200 g, requiriendo que los pacientes los utilizaran de 10 a 12 horas al día. El dispositivo debía ser retirado después de alcanzar la oclusión normal. Se midió el perfil cefalométrico de correlación de las radiografías laterales craneales, antes y después del tratamiento ortodóncico. Se observó mejoramiento en todos los pacientes con maloclusión de clase esquelética. Las mediciones SNA, ANB, APtm, MP-SN, ANS-Me / N-Me aumentaron, el avance y la reconstrucción maxilar fueron los cambios más significativos; la mandíbula giró en el sentido de las agujas del reloj, se observó un aumento de la inclinación labial de los dientes anteriores. Fue reducida la inclinación anterior del diente inferior, el ángulo nasolabial disminuyó y en general mejoró significativamente la apariencia. Las actividades combinadas de protrusión de la fuerza radiante pueden llevar a una mejora signficativa en el perfil de pacientes con dentición mixta de maloclusión clase III.

Palatal rugae characteristics and its relationship with Angle class 1, 2 & 3 malocclusions / Características de rugas palatinas y su relación con ángulos de maloclusiónes clase 1, 2 & 3

SUMMARY: The objectives of the study were to, 1. Compare the accuracy of four methods of acquisition of palatal rugae (PR) characteristics (PRC). 2. Study the predominant PRC in Angles Class 1, 2, and 3 malocclusions. 3. To statistically correlate the predominant PRC with Class 1, 2 & 3 malocclusions and thus explore the possibility of utilizing it in predicting malocclusions. Study casts and intraoral 3D scan images (3Shape® Intra-Oral Scanner) of the palate of 104 healthy orthodontic patients were included as Group I and Group II respectively. The casts of Group I were scanned using 3Shape® (Group III) and Sirona inEos X5® (Group IV) cast scanners. PRC for all groups were recorded and PRC of Group I was compared with PRC of Groups II, III and IV for possible matching. 3D images of Group IV were further divided according to Angles classification and predominant PRC analyzed. 97.8 % of PRC match was observed in Group I and Group IV. Wavy and complex rugae were predominant in Class 1 and 3 malocclusions and showed statistically significant difference between Class 1, 2 and 3 malocclusions (p=0.00 and 0.014 respectively) with wavy being higher in Class 1 and complex being higher in Class 3 (LSD Post Hoc analysis). Direct intraoral 3D scanning and 3D scanning of the palatal area of casts are equally reliable methods for PR acquisition for examining PRC. All PRC considered together have a minimal impact on prediction of malocclusions, however, influence of wavy characteristic was maximum.

RESUMEN: Los objetivos del estudio fueron los siguientes: 1. Comparar la precisión de cuatro métodos de adquisición de las características de la rugosidad palatina (CRP). 2. Estudiar las CRP predominantes en maloclusiones clases 1, 2 y 3. 3. Correlacionar estadísticamente las CRP predominantes con maloclusiones clase 1, 2 y 3 e investigar la posibilidad de utilizarlas en la predicción de maloclusiones. Se incluyeron en el Grupo I y en el Grupo II, los moldes de estudio y las imágenes de barrido 3D intraoral (3Shape® Intra-Oral Scanner) del paladar de 104 pacientes ortodónticos sanos. Los escaneos del Grupo I se escanearon utilizando escáner fundidos 3Shape® (Grupo III) y Sirona inEos X5® (Grupo IV). CRP para todos los grupos se registraron y CRP del Grupo I se comparó con las CRP de los Grupos II, III y IV para una posible coincidencia. Las imágenes 3D del Grupo IV se dividieron de acuerdo con la clasificación de ángulos y las CRP predominantes analizadas. Se observó un 97,8 % de concordancia en CRP en los grupos I y IV. Las rugas onduladas y complejas predominaron en las maloclusiones de Clases 1 y 3 y mostraron diferencias estadísticamente significativas entre las maloclusiones de Clases 1, 2 y 3 (p = 0,00 y 0,014 respectivamente), siendo el ondulado más alto en la Clase 1 y el complejo en la Clase 3 (LSD Post Hoc). El escaneo 3D intraoral directo y el escaneado 3D del área palatal son métodos igualmente confiables para la adquisición de CRP para el examen de las CRP. Todas las CRP consideradas en conjunto tienen algún grado de impacto en la predicción de las maloclusiones, sin embargo, fue mayor la influencia de la característica ondulada.

Cortical and cancellous bone in mandibular symphysis: implications in osteosynthesis and osteotomy / Hueso cortical y esponjoso en sínfisis mandibular: implicancias en osteotomía y osteosíntesis

The aim of this study was to quantify the presence of cortical and cancellous bone in the mandibular symphysis. A descriptive study was conducted using cone beam computed tomography where skeletal class I and class III subjects were included, defined according to characteristics detected on dental, clinical and dental occlusion x-rays. From the 3D reconstruction, sections were used in relation to the axial axis of the teeth of the anterior sector; the amount of buccal cortical, cortical, lingual, inferior cortical and cancellous bone as well as symphysis height were determined. The measurements were taken using routine methods and analyzed with ANOVA and Tukey's HSD test with p <0.05 for statistical significance. 20 skeletal class I subjects aged 23 years (± 4.5) and 20 class III subjects aged 22 years (± 5.2) were included. Symphysis height was significantly greater in skeletal class III subjects, exceeding by 0.8 mm the height of class I subjects; the buccal cortical bone presented on average 2 mm less at different dental levels, whereas the lingual cortical and inferior basal bones were significantly larger than the buccal cortical bone. The cancellous and cortical bones did not present any significant differences between the two groups (p=0.093). The buccal and basilar cortical bone is smaller than lingual cortical bone.

El objetivo fue determinar la presencia de hueso cortical y esponjoso en sínfisis mandibular. Se realizó un estudio descriptivo en tomografías computadorizadas cone beam donde se analizaron sujetos clase I y clase III esqueletal definidos según características dentales, clínicas y radiográficas de oclusión dental y características radiográficas. Desde la reconstrucción 3D se utilizaron cortes en relación al eje axial de los dientes del sector anterior; en ellos se determinó la cantidad de hueso cortical bucal, cortical, lingual, cortical inferior, hueso esponjoso y altura de sínfisis. Las mediciones fueron realizadas con métodos de rutina y fueron analizados con la prueba ANOVA y HDS Turkey considerando un valor de p <0.05 para considerar significancia estadística. 20 sujetos clase I esqueletal con 23 años (+ 4.5) y 20 sujetos clase III esqueletal con edad de 23 años (+ 4.5) fueron incluidos. La altura de sínfisis fue significativamente mayor en sujetos de clase III esqueletal, superando por 0.8 mm la altura de sujetos clase I; el hueso cortical bucal presento en promedio menor de 2 mm en diferentes niveles dentarios, mientras que la cortical lingual y basal inferior fueron significativamente mayor que la cortical bucal. El hueso esponjoso y hueso cortical no presentó diferencias significativas entre ambos grupos (p=0.093). La cortical bucal y basilar son menores que el hueso cortical lingual.

Inclinación de incisivos maxilares en sujetos con deformidad facial de clase III: opciones en cirugía primero / Maxillary incisor inclination in subjects with class III facial deformity: options in surgery first

El objetivo de esta investigación es determinar la inclinación de incisivos maxilares en sujetos con maloclusión de clase III. Se incluyeron 35 sujetos que presentaran deformidad facial de clase III (DF-III) para analizar la tomografía computarizada de haz cónico; las mediciones se realizaron para los cuatro incisivos maxilares identificando el plano palatino considerado entre espina nasal anterior y posterior y el eje axial dentario obtenido por la unión entre punto coronal y punto apical; los resultados mostraron angulaciones de 111,6 a 113,7 para los incisivos, lo cual permite obtener valores cercanos a la normalidad de angulación dentaria. Se concluye que los sujetos seleccionados presentan una angulación dentaria adecuada para la realización de procedimientos de cirugía primero.

The objective of this research was to determine the inclination of maxillary incisors in subjects with class III malocclusion. Were included 35 subjects with Class III facial deformity (DF-III) to analyze cone beam computed tomography; measurements were realized in the four maxillary incisors identifying the palatal plane considered between anterior and posterior nasal spine and dental axial axis from the union between coronal point and apical point; The results showed angulations from 111.6 to 113.7 for the incisors, which allows estimation of values close to normal dental angulation. It is concluded that the selected subjects present adequate dental angulation to perform surgery first.

Severe Angle Class III skeletal malocclusion associated to mandibular prognathism: orthodontic-surgical treatment

ABSTRACT The present case report describes the orthodontic treatment of a young adult patient (18y / 1m), Class III skeletal malocclusion, with mandibular prognathism and significant dental compensation. The canine relation was Class III, incisors with tendency to crossbite and open bite, moderate inferior crowding, and concave profile. Skeletal correction of malocclusion, facial profile harmony with satisfactory labial relationship, correction of tooth compensation and normal occlusal relationship were obtained with orthodontic treatment associated to orthognathic surgery. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO), as part of the requirements to become a BBO diplomate.

RESUMO O presente caso clínico descreve o tratamento ortodôntico de um paciente com 18 anos e 1 mês de idade, portador de má oclusão esquelética de Classe III, com prognatismo mandibular e significativa compensação dentária. A relação entre caninos era de Classe III, incisivos com tendência à mordida cruzada e mordida aberta, moderado apinhamento inferior, além de perfil côncavo. A correção esquelética da má oclusão; a harmonia do perfil facial, com relação labial satisfatória; correção da compensação dentária e relação oclusal normal foram obtidas com o tratamento ortodôntico associado à cirurgia ortognática. Esse caso foi apresentado à Diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO), como parte dos requisitos para a obtenção do título de Diplomado pelo BBO.

Comparison of arch forms between Turkish and North American

ABSTRACT Objective: The aim of this study was to clarify the morphological differences in the mandibular arches of Turkish and North American white subjects. Methods: The sample included 132 Turkish (34 Class I, 58 Class II, and 40 Class III) and 160 North American (60 Class I, 50 Class II, and 50 Class III) subjects. The most facial portion of 13 proximal contact areas was digitized from photocopied images of patients' mandibular dental arches. Clinical bracket points were calculated for each tooth based on mandibular tooth thickness data. Four linear and two proportional measurements were taken. The subjects were grouped according to arch form types (tapered, ovoid and square) in order to have frequency distribution compared between ethnic groups in each Angle classification. Results: The Turkish group showed significantly lower molar depth and more significant molar width-depth (W/D) ratio in all three Angle classifications. On the other hand, the Turkish group also showed a significantly larger intercanine width in Class III malocclusion and intermolar width in Class II malocclusion. The most frequent arch forms seen were the ovoid arch form in the Turkish group and the tapered form in the white group. Conclusions: Our results demonstrate that when treating Turkish patients, one should expect to use preformed ovoid arch form orthodontic wires in a significant percentage of patients.

RESUMO Objetivo: o objetivo deste estudo foi avaliar as diferenças morfológicas entre as arcadas dentárias inferiores de indivíduos turcos e indivíduos norte-americanos leucodermas. Métodos: a amostra incluiu 132 indivíduos turcos (34 Classe I, 58 Classe II e 40 Classe III) e 160 norte-americanos (60 Classe I, 50 Classe II e 50 Classe III). A porção mais vestibular de 13 áreas de contato proximal foi digitalizada a partir de imagens impressas das arcadas dentárias inferiores dos pacientes. Os pontos de colagem dos braquetes foram calculados, para cada dente, com base em dados referentes à espessura dos dentes inferiores. Quatro medidas lineares e duas proporcionais foram obtidas. Os indivíduos foram classificados de acordo com o formato da arcada (triangular, oval e quadrada), permitindo que a frequência de cada formato fosse comparada entre os grupos étnicos, e dentro de cada classificação de Angle. Resultados: o grupo composto por indivíduos turcos apresentou profundidade da arcada na região dos molares significativamente menor, além de uma proporção largura/profundidade da arcada na região dos molares maior em todas as classificações de Angle. Em contrapartida, esse mesmo grupo mostrou maiores distâncias intercaninos nos pacientes Classe III e intermolares nos pacientes Classe II. A arcada oval foi a mais frequente no grupo composto por indivíduos turcos, enquanto a arcada triangular foi a mais frequente no grupo composto por indivíduos norte-americanos leucodermas. Conclusões: os resultados obtidos mostram que, ao tratar pacientes turcos, o profissional deve prever o uso de arcos ortodônticos pré-conformados ovais em um percentual significativo dos pacientes.

Avaliação das vias aéreas superiores por meio de tomografia computadorizada Cone-beam em pacientes Classe III submetidos à cirurgia bimaxilar / Evaluation of the upper airways by means of Cone-beam computed tomography in Class III patients submitted to bimaxilar surgery

Introdução: Dependendo da magnitude da má oclusão de Classe III, esta é uma alteração difícil de ser tratada apenas com a correção ortodôntica. Tanto as cirurgias de recuo mandibular quanto as bimaxilares promovem uma melhora na oclusão, na função mastigatória e na estética facial, ao corrigirem as posições da mandíbula e/ou maxila, mas um importante aspecto da cirurgia ortognática, que não pode ser negligenciado, são os efeitos que os movimentos esqueléticos das bases ósseas podem provocar na região das vias aéreas, ao alterar a posição do osso hióide e da língua. O estreitamento das vias aéreas superiores (VAS) pode comprometer o sono dos pacientes submetidos à correção cirúrgica e predispor ao desenvolvimento da apneia/hipopneia obstrutiva do sono (AOS). Objetivos: O presente trabalho tem como objetivo avaliar as alterações de volume e área axial mínima do espaço aéreo faringeo em pacientes com má oclusão de Classe III esquelética, submetidos à cirurgia ortognática bimaxilar, pela técnica de osteotomia Le Fort I da maxila e osteotomia sagital bilateral da mandíbula. Material e Métodos: As avaliações foram feitas em tomografias computadorizadas Cone-beam, utilizando-se o Programa Dolphin Imaging 11.7. As tomografias de 50 pacientes, de ambos os sexos, com média de idade de 33,40 (± 9,38) anos, foram analisadas nos períodos pré e pósoperatório e as medidas de volume e área axial mínima foram mensuradas. Foi utilizado o teste t pareado e os testes foram realizados utilizando-se o programa Statistica 7.0, adotando-se um nível de significância de 5%. Resultados: ao calcular o erro do método, não foram encontrados erros casuais e nem sistemáticos (p> 0,05 em todas as medidas). As cirurgias bimaxilares para correção da Classe III esquelética promoveram um aumento de 16,68% (±22,61) no volume e 23,58% (± 31,46) na área axial mínima. Conclusões: Mesmo que os efeitos da cirurgia de avanço maxilar e recuo mandibular sobre as vias aéreas não sejam completamente previsíveis, podemos observar que a maioria dos pacientes não apresentaram prejuízos na anatomia faringeana que resulte em diminuição do volume aéreo e área axial mínima, predispondo-o ao desenvolvimento da AOS.(AU)

Introduction: Depending on the extend of Class III malocclusion, it becomes difficult to be treated only with orthodontic correction. Both mandibular setback surgery as bimaxillary surgery, promote an improvement in occlusion, masticatory function and facial aesthetics, correcting the position of the mandible and/or maxilla. But an important aspect of orthognathic surgery that cant be overlooked, are the effects that the skeletal movements of the bone bases causes in the airway space, since they change the position of the hyoid bone and tongue. The narrowing of the pharingeal airway space (PAS) may impair the patient's sleep and predispose to the development of obstructive sleep apnea (OSA). Purpose: This study aims to evaluate surgical changes in the airway volume and minimal cross-sectional area in the pharyngeal airway space (PAS) in patients with skeletal Class III malocclusion, submitted to bimaxillary surgery, using a Le Fort I maxillary osteotomy and bilateral sagittal split ramus osteotomy technique. Material and Methods: The evaluations were made through Cone-beam computed tomography (CBCT), using Dolphin Imaging program version 11.7. The CT scans of 50 patients of both genders, with a mean age of 33.40 (± 9.38), were analyzed pre and postoperatively and volume and minimum axial area were measured. Paired t test was used and tests were performed using Statistica 7.0 software, adopting a 5% significance level. Results: Method error were done and no random or systematic errors were found (p> 0.05 for all measures). Bimaxillary surgery for skeletal Class III correction promoted an increase of 16.68% (± 22.61) in volume and 23.58% (± 31.46) at the minimum axial area. Conclusion: Even if the effects of the maxillary advancement and mandibular setback surgery on the airway are not completely predictable, we observed that most patients didnt have pharyngeal airway anatomy damage, that could result decreased on airway volume and minimum axial area predisposing to OSA development.(AU)

Effects of reverse headgear on pharyngeal airway in patients with different vertical craniofacial features

The aim of this study was to investigate the effects of reverse headgear (RH) on pharyngeal airway morphology in two groups of Class III patients with different vertical craniofacial features in comparison with an untreated Class III group. Seventeen subjects (9 males, 8 females; mean age 11.3 ± 0.98 years) with optimum vertical growth and 17 subjects (10 males, 7 females, mean age 11.5 ± 1.1 years) with a vertical growth pattern treated with a removable intra-oral appliance and a Delaire type facemask were included. An untreated Class III control group of 11 subjects (8 males, 3 females, mean age 9.1 ± 1.1 years) was included to compare the treated groups. The paired t-test for intragroup and one-way ANOVA for intergroup comparisons were performed. The relationships between changes in the craniofacial morphology and airway were assessed by Spearman correlation analysis. The airway dimensions at the adenoid side and soft palate were increased in the treatment groups compared to the control group (p < 0.05). The nasopharyngeal area demonstrated a significant difference in normodivergent and control subjects (p < 0.05). No significant difference was found in the airway morphology due to different vertical features. The effect of RH treatment on the sagittal airway dimensions revealed no significant difference between different vertical craniofacial features in the short term.

Facial soft tissue in subjects with class II and class III facial deformities: preliminary results / Tejido blando facial en sujetos con deformidad facial clase II y clase III: resultados preliminares

Class II and class III skeletal anomalies require treatments that are both esthetic and functional, so the purpose of this investigation was to study the relationship between facial soft and hard tissues of patients with class II and class III deformities in the lower third of the face. A descriptive study was designed which included class II subjects with a SNB angle less than 78 and class III with a SNA angle less than 80. The soft tissue width was analyzed in relation to the Pg point, A point, B point, and upper and lower incisor cervical points. The naso-labial angle and interincisal angle were also analyzed. The studies were done using cone beam computerized tomography and analyzed with the software Simplant O&O (Materialise, Belgium). The results revealed similarities in the measurements of the facial width soft tissues with differences of less 1 mm in the Pg point, A point, B point, upper incisor point; the greatest differences were observed between the two groups in thelower incisor cervical point, with almost 5 mm difference in tissue size. The naso-labial angle also presented differences between the two groups, being more closed in the class III than in the class II subjects (approximate difference of 6). It can be concluded that there are minimal differences in the soft tissue width in class II and class III subjects; other parameters can be analyzed to search for differences that influence treatment planning and strategies for these patients.

Las anomalías esqueletales de clase II y clase III requieren tratamientos que asocian estética y función. El objetivo de esta investigación fue estudiar la relación entre tejidos blandos y duros faciales de pacientes con clase II y clase III facial, a nivel del tercio inferior facial. Se diseño un estudio descriptivo donde se incluyeron sujetos clase II con un ángulo SNB menor de 78 y clase III con un ángulo SNA menor de 80. Se analizó el ancho de tejidos blandos en relación a los putos Pg, punto A, punto B, y puntos cervicales de dientes incisivos maxilar y mandibular; también se analizaron los ángulos nasolabial e interincisivo; los estudios se realizaron en tomografía computadorizada cone beam y analizados en el software Simplant O&O (Materialise, Belgium). Los resultados demostraron semejanzas en las mediciones obtenidas en el ancho facial de tejidos blandos con diferencias menores a 1 mm en los puntos Pg, punto A, punto B y cervical incisivo maxilar; en relación al punto cervical del incisivo mandibular se observaron las mayores diferencias entre ambos grupos, cercanas a 5 mm de diferencia de tamaño en los tejidos; el ángulo nasolabial también presento diferencias entre ambos grupos, siendo en los sujetos clase III mas cerrado que en sujetos clase II (diferencia aproximada de 6). Se puede concluir que existen mínimas diferencias en el ancho de tejidos blandos en sujetos de clase II y clase III; otros parámetros pueden ser analizados para búsqueda de diferencias que influyan en planificaciones y estrategias terapéuticas para estos sujetos.

Dentoskeletal effects of Class II malocclusion treatment with the Twin Block appliance in a Brazilian sample: A prospective study

OBJECTIVE: The aim of this study was to assess the dentoskeletal effects of Class II malocclusion treatment performed with the Twin Block appliance. METHODS: The experimental group comprised 20 individuals with initial mean age of 11.76 years and was treated for a period of 1.13 years. The control group comprised 25 individuals with initial mean age of 11.39 years and a follow-up period of 1.07 years. Lateral cephalograms were taken at treatment onset and completion to assess treatment outcomes. Intergroup comparison was performed by means of the chi-square and independent t tests. RESULTS: The Twin Block appliance did not show significant effects on the maxillary component. The mandibular component showed a statistically significant increase in the effective mandibular length (Co-Gn) and significant improvement in the maxillomandibular relationship. The maxillary and mandibular dentoalveolar components presented a significant inclination of anterior teeth in both arches. The maxillary incisors were lingually tipped and retruded, while the mandibular incisors were labially tipped and protruded. CONCLUSIONS: The Twin Block appliance has great effectiveness for correction of skeletal Class II malocclusion in individuals with growth potential. Most changes are of dentoalveolar nature with a large component of tooth inclination associated with a significant skeletal effect on the mandible. .

OBJETIVO: avaliar os efeitos dentoesqueléticos do tratamento da má oclusão de Classe II com o aparelho Twin Block comparado a um grupo controle. MÉTODOS: o grupo experimental foi composto por 20 pacientes com idade inicial média de 11,76 anos e que foram tratados por um período de 1,13 anos. O grupo controle foi composto por 25 indivíduos com idade inicial média de 11,39 anos e que foram acompanhados por um período de 1,07 anos. Telerradiografias em norma lateral foram obtidas ao início e final do tratamento para avaliar as alterações decorrentes do tratamento. A comparação intergrupos foi realizada por meio do teste qui-quadrado e do teste t independente. RESULTADOS: o aparelho Twin Block não apresentou alterações significativas no componente maxilar. O componente mandibular revelou um aumento estatisticamente significativo do crescimento efetivo da mandíbula (Co-Gn) e uma melhora significativa da relação existente entre as bases ósseas. Os componentes dentoalveolar superior e inferior apresentaram um significativo componente de inclinação dos dentes anteriores em ambas as arcadas. Os incisivos superiores foram inclinados para lingual e retruídos, ao passo que os incisivos inferiores foram inclinados para vestibular e protruídos. CONCLUSÕES: o aparelho Twin Block apresenta grande efetividade na correção da má oclusão de Classe II esquelética em pacientes em fase de crescimento. A maior parte das alterações ocorridas é de natureza dentoalveolar, com um grande componente de inclinação dentária associado a um significativo efeito esquelético na mandíbula. .

Intercanine and intermolar widths in angle class I, II and III malocclusions

Malrelation along the transverse plane is one of the most common causes of malocclusion and can be assessed by considering the intercanine and intermolar widths. An endeavour was undertaken to find the intercanine and intermolar widths on 76 dental casts of the individuals having Class I, Class II division 1, Class II division 2, Class III and Class II subdivision malocclusions, visiting orthodontic department of Sardar Begum dental college and hospital, Peshawar. Results were obtained using SPSS version 20 which showed the mean maxillary intermolar widths of 34.6mm*, 34.5mm, 30.9mm, 34.7 mm and 34.18mm for Class I, Class II division 1,Class II division 2,Class III and Class II subdi-vision groups respectively. Mean maxillary intercanine widths were found to be 24.16mm, 24.5mm, 24.6mm, 23.9mm and 23.05mm for Class I, Class II division 1,Class II division 2,Class III and Class II subdivision groups respectively. Similarly mean mandibular intermolar widths were 32.8mm, 33.02mm, 30.3mm, 33.1mm and 32.8mm for Class I, Class II division 1, Class II division 2, Class III and Class II subdivision groups respectively. While mean mandibular intercanine widths were found to be 19.2mm,19.06mm,20.34mm,19.54mm and 18.75mm for the Class I, Class II division 1,Class II division 2,Class III and Class II subdivision groups respectively. ANOVA analysis showed no sta-tistical significant differences in the intermolar and intercanine widths among the five malocclusion groups

Tratamento da maloclusão de classe III com o aparelho regulador de função 3 (RF-3) de frankel / Treatment ot class 111 malacclusian with the functian regulatar 3 appliance (RF-3) af frankel

Este trabalho teve como objetivo descrever um caso clínico de maloclusão classe 111 com mordida cruzada anterior e sobremordida profunda tratado com o Regulador de Função 3 de Frankel, acompanhado por três anos. Em cada fase foi obtida documentação ortodôntica e observou-se nas avaliaçôes clínicas e cefalométricas evolução favorável principalmente em relação à rotação horária da mandíbula, descruzamento da mordida e das grandezas cefalométricas no decorrer do tratamento, respectivamente concluímos que o Regulador de Função 3 de Frankel é um recurso efetivo no tratamento da maloclusão de classe 111 com mordida cruzada e sobremordida profunda em indivíduos em fase de crescimento.

This paper had as objective describes a clinical case of class 111 malocclusions with anterior crossbite and deep bite agreement with the Function Regulator 3 of Frankel, accompanied by 3 years. In each phase it was obtained orthodontic documentation and it was observed mainly in the clinical evaluations and cephalometric favorable evolution in relation to the mandible rotation, correction of the bite and of the cephalometric measures in elapsing of the treatment respectively. This work concluded that the Function Regulator 3 of Frankel is an effective resource in the treatment of the class 111 malocclusions with anterior crossbite and deep bite in individuais in growth phase.

Clase III por hipodesarrollo del maxilar superior / Class III by hipodevelopment of the upper jaw

La clase III tiene su origen en diferentes factores. Uno de ellos es el deficiente desarrollo del maxilar superior que se puede dar en los tres planos del espacio. Es frecuente observar dos tipos de deficiencia, una fundamentalmente transversal con menor afección horizontal y vertical, y la otra mayormente horizontal o vertical con dimensión transversal razonablemente normal. Ambos tipos poseen rasgos faciales, intraorales y funcionales particulares que los distinguen. Siempre que se presente hipodesarrollo del maxilar superior, independientemente del plano de mayor o menor afección, debe ser tratado en forma precoz, combinando fuerzas ortopédicas y ortodónticas. Los resultados del tratamiento deben cumplir objetivos dentarios, faciales y funcionales.

Analysis of Soft Tissue Changes after Genioplasty in Skeletal Class III Dentofacial Deformity

PURPOSE: The purpose of this study was to measure the anteroinferior changes and the degree of vertical changes to facilitate the prediction of treatment outcome in patients undergoing genioplasty only, genioplasty with bilateral sagittal split ramus osteotomy (BSSRO), genioplasty, or BSSRO and Lefort I osteotomy. MATERIALS AND METHODS: Serial cephalometry was performed on 25 patients at 1-year follow-up after genioplasty, to assess skeletal changes and relapse. Surgery was performed using conventional techniques. RESULTS: The mean ratio was 0.9 : 1 of soft tissue to skeletal movement at pogonion, but the average difference between hard and soft tissue was large; thus, the prediction of anteroposterior soft tissue changes was quite inaccurate. CONCLUSION: We observed a good correlation between the amount of hard versus soft tissue change with surgery in the horizontal direction, but a poor correlation in the vertical plane.

[Evaluation of condylar height and width in patients with class I and class III Malocclusions using panoramic and lateral cephalogram]

Situation of the condyle in glenoid fossa has a direct effect on the anteroposterior or vertical position of the mandible. Therefore, condylar situation and its shape has a special significance on producing facial morphology. The aim of this study was to evaluate the condylar height and width in patients with class III and class I malocclusion by using panoramic radiographs and lateral cephalograms. This study was performed on 80 pretreatment lateral cephalograms and panoramic films. Mean age in girls was 11 years and 4 months and in boys, it was 12 years and 2 months. Condylar characteristics were surveyed from the point of condylar width and condylar height. Condylar height was surveyed on the panoramic film. Condylar width was analyzed on the lateral cephalograms. Data were analyzed using t.test and ANOVA. Patients with class I malocclusion had a significantly longer condylar width relative to the patients with class III malocclusion. The condylar height in class III malocclusions was longer than class I malocclusion. This study revealed that in patients with class III malocclusion, condylar height was longer but condylar width was smaller than class I malocclusion

Características morfológicas da sínfise mandibular e do incisivo inferior na má oclusão de classe III com indicação de recuo mandibular cirúrgico / Morphological characteristics of mandibular symphysis and lower incisor in class malocclusion requiring mandibular setback surgery

Este resumo teve como propósito definir as características morfológicas da sínfise mandibular e do incisivo inferior em pacientes com má oclusão de Classe III com indicação de recuo mandibular isolado. A amostra experimental foi constituida por 16 pacientes, na faixa etária média de 21 anos e 11 meses, apresentando má oclusão de Classe III represnetada por protusão mandibular. Para cada paciente foi realizada uma telerradiografia nas fase pré-tratamento, sendo comparada a um grupo controle constituído de indivíduos com oclusão normal. De acordo com a metodologia empregada, os resultados obtidos a partir de variáveis cefalométrricas angulares, lineares e proporcionais foram avaliados estatisticamente. Constatou-se uma compensação para a má oclusão referida, estando os incisivos inferiores e sínfise mandibular lingualizados, morfologicamente diferente dos indivíduos com oclusão normal. O processo alveolar e a região basal da sínfise mandibular e as corticais ósseas vestibular das regiões referidas apresentaram-se lingualizadas, considerando-se o plano mandibular ocasionando uma curvatura menos pronunciada entre a sregiões alveolar e basal propriamente ditas e suas corticais óssea vestibular. Nestes pacientes, o mento ósseo apresnetou-se mais pronunciado e o processo alveolar, a porção basal e a altura da sínfise mandibular apresentaram-se diminuídos. Já a latura da sínfise não apresentou diferença estatisticamente significante em relação ao normal. O incisivo inferior apresentou diferença significante em relação ao processo alveolar

Cephalometric evaluation of Class III malocclusion by a modified Tweed-Merrifield analysis

A sample of cephalograms of 20 White Brazilian subjects (9 males, 11 females) of 17-36 years old, who presented Class III dental malocclusion was selected and traced. Results showed statistically significant differences among genders for FMIA, SNA, SNB, 1.NB, PFH, AFH, 1-NB and mandibular length. Anteroposterior jaw relation, as shown by SNA and SNB, presented a maxilla correctly positioned, as well as mandibular protrusion, which was related to a normal upper jaw length and an augmented lower jaw length. A vertical growth pattern prevailed, as evidenced by FMA, AFH, PHF and OCC.PL. Angle. The Z Angle, total chin and upper lip failed to clearly show any disturbance of facial esthetics and IMPA, 1.NA, 1-NA, 1.NB and 1-NB revealed dental compensation