Planejamento virtual em cirurgia ortognática: relato de caso / Virtual planning for orthognathic surgery: case report / Planificación virtual en cirugía ortognática: reporte de caso

Introdução: A correção das deformidades dentofaciais depende do bom diagnóstico, da precisão do planejamento e da correta execução da técnica cirúrgica. Buscando maior precisão, o planejamento virtual para cirurgia ortognática tem sido uma ferramenta amplamente aplicada pela cirurgia bucomaxilofacial. Este trabalho demonstra, por meio de caso clínico, os benefícios adquiridos pelo planejamento virtual, no que diz respeito a quantificação do movimento, avaliação da predição dos tecidos moles e osteotomias, assim como discorre sobre os cuidados e passos necessários para um correto planejamento. Relato do caso: Paciente de perfil classe II, submetida ao protocolo de planejamento virtual com aquisição de imagens tomográficas, escaneamento intraoral e utilização de software digital para avaliação diagnóstica, planejamento e impressão dos guias cirúrgicos. A mesma foi acompanhada durante 3 meses de pós operatório, apresentando boa precisão e previsibilidade nos movimentos cirúrgicos realizados. Discussão: Ao se realizar uma avaliação clínica acurada, somada a aquisição de imagens tridimensionais, a partir das tomografias de face, escaneamentos intraorais e o manejo da tecnologia CAD/CAM, é possível se alcançar maior precisão no planejamento e predictibilidade cirúrgica, bem como realizar um melhor diagnóstico das deformidades transversas. Contudo, deve-se levar em consideração a necessidade de conhecimento teórico-prático para a correta execução dos passos para o planejamento virtual. Considerações finais: Dado o exposto, foi possível observar precisão no resultado obtido e compatibilidade entre os movimentos planejados e executados. Assim como, demonstrou se aspectos relativos a cada um dos passos para o protocolo virtual, expondo-se suas particularidades e diferenças em relação ao planejamento convencional... (AU)

Introducción: La corrección de las deformidades dentofaciales depende de un buen diagnóstico, de la precisión de la planificación y la correcta ejecución de la técnica quirúrgica . Buscando mayor precisión, la planificación virtual para cirugía ortognática ha sido una herramienta aplicada ampliamente por la cirugia bucomaxilofacial. Este trabajo demuestra, por medio de un caso clínico, los beneficios obtenidos por la planificación virtual, en lo que respecta a la cuantificación del movimiento, evaluación de la predicción de los tejidos blandos y de las osteotomia, así enfatizando los cuidados y pasos necesarios para una correcta planificación. Relato de caso: Paciente con perfil clase II, utilizando protocolo de planificación virtual con adquisición de imágenes tomográficas, escaneamento intra-oral y uso de software digital para evaluación diagnóstica, planificación e impresión 3D de los guías quirúrgicos. La paciente tuvo seguimiento pos operatorio por tres meses, corroborando la precisión y previsibilidad de los movimientos quirúrgicos planificados y ejecutados. Discusión: Al realizarse una evaluación clínica acurada, sumando una adquisición de imágenes tridimensionales, a partir de la tomografía facial, escaneamento intra-oral y el manejo de tecnologia CAD/CAM, es posible alcanzar mayor precisión en la planificación y previsibilidad quirúrgica, así como un diagnóstico más acurado de las alteraciones transversas. Con todo, se debe considerar la necesidad de conocimiento teórico práctico para la correcta elaboración de un proyecto de planificación quirúrgica virtual. Consideraciones finales: Por lo expuesto, se observó precisión en el resultado obtenido considerando los movimientos planificados y ejecutados. Así como se describió aspectos relativos a cada uno de los pasos del protocolo virtual utilizado, exponiendo sus particularidades y diferencias en relación a la planificación quirúrgica convencional... (AU)

Introduction: The correction of dentofacial deformities depends directly on a good diagnosis, the precision of the surgical planning and the correct execution of the technique. Seeking greater precision, virtual planning for orthognathic surgery has been a tool widely applied in oral and maxillofacial surgery. This work demonstrates, through a case report, the benefits acquired by virtual planning, regarding the quantification of movement, evaluation of the prediction of soft tissues and osteotomies, as well as discusses the accuracy and steps necessary for a correct planning. Case report: Class II facial profile patient, submitted to the virtual planning protocol with acquisition of tomographic images, intraoral scanning and use of digital software for diagnostic evaluation, planning and printing of surgical guides. She was followed up for 3 months after the operation, showing good precision and predictability in the surgical movements performed. Discussion: When performing an accurate clinical evaluation, added up to the acquisition of three-dimensional images, from face tomography, intra-oral scans and the management of CAD/CAM technology, it is possible to achieve greater precision in surgical planning and predictability, as well as accomplish a better diagnosis of transverse deformities. However, one must take into account the need for theoretical practical knowledge for the correct execution of the steps for virtual planning. Final considerations: Given the above, it was possible to observe precision in the result obtained and compatibility between the planned and executed movements. As well, aspects related to each of the steps for the virtual protocol were demonstrated, exposing their particularities and differences in relation to conventional planning... (AU)

Análise das vias aéreas superiores pós cirurgia ortognática bimaxilar: estudo retrospectivo / Upper airway analysis after bimaxillary orthognathic surgery: retrospective study / Análisis de la vía aérea superior después de la cirugía ortognática bimaxilar: estudio retrospectivo

Objetivo: O objetivo do presente estudo foi avaliar retrospectivamente as mudanças ocorridas nas vias aéreas superiores (VAS) pós cirurgia ortognática bimaxilar. Metodologia: A amostra compreendeu 14 pacientes, que foram divididos em dois grupos, conforme o tipo de movimentação realizada na cirurgia: grupo 1 (n = 6), avanço bimaxilar; grupo 2 (n = 8) cirurgia de avanço de maxila e recuo de mandíbula. Foram realizadas tomografias computadorizadas no pré-operatório (T0) e pós-operatório de 1 ano (T1). Através do software Dolphin Imaging procedeu-se a análise das VAS em três parâmetros: área total (AT), volume total (VT) e área axial mínima (AAM), que foram comparadas entre T0 e T1 em um mesmo grupos pelo Teste de Wilcoxon e entre grupos pelos Teste de Mann-Whitney (p < 0.05). Resultados: Ambos os grupos apresentaram aumento significativo de AT, VT e AAM entre T0 e T1. Contudo, essas variações foram estatisticamente maiores no grupo 1 quando comparadas ao grupo 2. Conclusão: As cirurgias bimaxilares promoveram o aumento da AT, VT e AAM das VAS e essas mudanças foram significativamente superiores nos pacientes submetidos ao avanço bimaxilar... (AU)

Objective: The objective of the present study was to retrospectively evaluate the changes that occurred in the upper airways (UAS) after bimaxillary orthognathic surgery. Methodology: The sample comprised 14 patients, who were divided into two groups, according to the type of movement performed in the surgery: group 1 (n = 6), bimaxillary advancement; group 2 (n = 8) maxillary advancement and mandibular setback surgery. Computed tomography scans were performed preoperatively (T0) and 1 year postoperatively (T1). Through the Dolphin Imaging software, the analysis of the UAS was carried out in three parameters: total area (TA), total volume (TV) and minimum axial area (MAA), which were compared between T0 and T1 in the same groups by the Wilcoxon Test and between groups by the Mann-Whitney test (p < 0.05). Results: Both groups showed a significant increase in TA, TV and MAA between T0 and T1. However, these variations were statistically higher in group 1 when compared to group 2. Conclusion: Bimaxillary surgeries promoted an increase in the TA, TV and MAA of the UAS and these changes were significantly higher in patients undergoing bimaxillary advancement... (AU)

Objetivo: El objetivo del presente estudio fue evaluar retrospectivamente los cambios ocurridos en las vías aéreas superiores (VAS) después de la cirugía ortognática bimaxilar. Metodología: La muestra estuvo compuesta por 14 pacientes, quienes fueron divididos en dos grupos, según el tipo de movimiento realizado en la cirugía: grupo 1 (n = 6), avance bimaxilar; grupo 2 (n = 8) cirugía de avance maxilar y retroceso mandibular. Las tomografías computarizadas se realizaron antes de la operación (T0) y 1 año después de la operación (T1). A través del software Dolphin Imaging se realizó el análisis de la VAS en tres parámetros: área total (AT), volumen total (VT) y área axial mínima (AAM), los cuales fueron comparados entre T0 y T1 en los mismos grupos por el Prueba de Wilcoxon y entre grupos por la prueba de Mann Whitney (p < 0,05). Resultados: Ambos grupos mostraron un aumento significativo de AT, VT y AAM entre T0 y T1. Sin embargo, estas variaciones fueron estadísticamente mayores en el grupo 1 en comparación con el grupo 2. Conclusión: Las cirugías bimaxilares promovieron un aumento de la AT, VT y AAM de las VAS y estos cambios fueron significativamente mayores en los pacientes sometidos a avance bimaxilar... (AU)

Discrepancia negativa transversal del maxilar y factores asociados en pacientes con necesidad de cirugía ortognática / Negative transverse maxillary discrepancy and associated factors in patients requiring orthognathic surgery

Introducción: La discrepancia transversal de las arcadas es un problema esquelético poco estudiado en personas con necesidad de tratamiento ortodóncico quirúrgico. Objetivo: Caracterizar a pacientes con discrepancia negativa transversal del maxilar y necesidad de tratamiento por cirugía ortognática. Métodos: Se realizó un estudio descriptivo de corte transversal en 25 expedientes clínicos de pacientes que acudieron al servicio de cirugía maxilofacial del Hospital Clínico Quirúrgico Hermanos Ameijeiras, con discrepancia negativa transversal del maxilar y necesidad de cirugía ortognática entre enero de 2016 y enero de 2020. Se estudiaron los casos por medio de variables cualitativas divididas en epidemiológicas, características faciales y mediciones dentarias. Para el análisis se confeccionaron cuadros estadísticos y como medidas de resumen se utilizaron frecuencias absolutas y relativas. Resultados: La frecuencia de la discrepancia negativa del maxilar fue de 13,3 por ciento. Los pacientes de piel blanca fueron los más afectados (80 por ciento) y el principal motivo de consulta fue estético (68 por ciento). La asimetría del tercio inferior y el perfil cóncavo estuvieron presentes en el 44 por ciento y 36 por ciento de los casos respectivamente. Se observó alta frecuencia de pacientes con el tercio inferior aumentado (76 por ciento), mordida cruzada posterior (48 por ciento), mordida abierta anterior (75 por ciento), apiñamiento en la arcada inferior (63,3 por ciento) y lingualización del incisivo inferior (72 por ciento). Conclusiones: La discrepancia negativa transversal del maxilar es frecuente en personas con necesidad de cirugía ortognática y con gran afectación estética. Se observó mayor predisposición a padecerla en pacientes de piel blanca(AU)

Introduction: Transverse discrepancy of the arches is a skeletal problem not sufficiently studied in persons requiring surgical orthodontic treatment. Objective: Characterize patients with negative transverse maxillary discrepancy requiring surgical orthognathic surgery. Methods: A descriptive cross-sectional study was conducted of 25 medical records of patients attending the maxillofacial surgery service at Hermanos Ameijeiras Clinical Surgical Hospital with negative transverse maxillary discrepancy requiring orthognathic surgery from January 2016 to January 2020. The cases were studied with qualitative variables divided into epidemiological, facial features and dental measurements. Analysis was based on statistical charts. The summary measurements used were absolute and relative frequencies. Results: The frequency of negative maxillary discrepancy was 13.3 percent. White skin patients were more commonly affected (80 percent). The main concern was aesthetic (68 percent). Lower third asymmetry and a concave profile were present in 44 percent and 36 percent of the cases, respectively. A high frequency was observed of patients with an augmented lower third (76 percent), posterior crossbite (48 percent), anterior open bite (75 percent), lower arch crowding (63.3 percent) and lower incisor lingualization (72 percent). Conclusions: Negative transverse maxillary discrepancy is common among patients requiring orthognathic surgery for large aesthetic alterations. White skin patients were found to be more prone to present this disorder(AU)

Implant-supported Dental Prosthesis and Orthognathic Surgery for Rehabilitation of Patients with Obstructive Sleep Apnea / Prótese Dentária Implanto-suportada e Cirurgia Ortognática para Reabilitação de Pacientes com Apneia Obstrutiva do Sono

Among the treatment options for Obstructive Sleep Apnea (OSA) we have surgery to correct dentofacial deformities. OSA patients are routinely and predictably submitted to surgical treatment for dentofacial deformities. Frequently, orthognathic surgery and osseointegrated implants may be necessary to enable fixed rehabilitation. Patients submitted to orthognathic surgery have a transient decrease in blood supply after maxillary and mandibular osteotomy procedures, which can impair the results in these cases. This case report aimed to present and discuss the conflicting situation of an OSA patient in need of orthognathic surgery and dental implants. The treatment consisted of: (1) extraction of all teeth; (2) complete rehabilitation of the upper and lower jaw with dental implants and prosthesis without compensation; (3) bimaxillary orthognathic surgery to re-establish the maxillomandibular relationship and increase the upper airway volume. This rehabilitation sequence was a safe alternative for a case of Class II OSA, and rapidly achieved a final restoration with enhanced esthetics, functionality, biomechanics, maintenance of oral hygiene, and patient satisfaction (AU)

Entre as opções de tratamento da Apneia Obstrutiva do Sono (AOS) temos a cirurgia para correção das deformidades dentofaciais. Freqüentemente, a combinação de cirurgia ortognática e implantes osseointegráveis pode ser necessária para permitir a reabilitação dental. Pacientes submetidos à cirurgia ortognática apresentam diminuição transitória do suprimento sanguíneo após procedimentos de osteotomia maxilar e mandibular, o que pode prejudicar os resultados nestes casos. Este relato de caso teve como objetivo apresentar e discutir a situação de um paciente com AOS que necessita de cirurgia ortognática e implantes dentários. O tratamento consistiu em: (1) extração de todos os dentes; (2) reabilitação completa da mandíbula superior e inferior com implantes dentários e próteses sem compensação; (3) cirurgia ortognática bimaxilar para restabelecer a relação maxilomandibular e aumentar o volume das vias aéreas superiores. Essa sequência de reabilitação foi uma alternativa segura para um caso de AOS Classe II, e rapidamente alcançou uma reabilitação com estética, funcionalidade, biomecânica aprimorada, manutenção da higiene oral e satisfação do paciente

Breathing pattern, orthognathic surgery and head posture in dentofacial deformity / Padrão respiratório, cirurgia ortognática e postura de cabeça na deformidade dentofacial

Abstract Introduction: Dentofacial deformity (DFD) and the breathing mode can change the head posture. However, head posture changes after orthognathic surgery are controversial, and no studies were found on the relationship between the head posture and breathing mode in adults with DFD. Objective: To identify the main head posture changes in young adults affected by DFD, to verify if orthognathic surgery modifies the breathing mode and head posture, and if the breathing mode is associated with the head posture. Methods: Twenty-five young adults were assessed and divided in dentofacial deformity group (DFD; n = 15; x̅ = 28 years) and control group with dentofacial harmony (CG; n = 10; balanced by gender and age with the study group). Breathing mode was evaluated according to the orofacial myofunctional evaluation protocol, and biophotogrammetry was used in the head posture analyses. For the DFD group, the evaluations were performed pre and post the orthognathic surgery (pre- and post-DFD). Results: For the DFD group, the breathing mode modified after orthognathic surgery (p = 0.003), but with difference from GC (p = 0.027). No changes were found in head posture after orthognathic surgery, but significant difference was seen between post-DFD and GC for head inclination (p = 0.017). No relationship was observed between breathing mode and head posture (p > 0.05). Conclusion: After orthognathic surgery, a spontaneous improvement of breathing was seen in the sample. It was not possible to verify changes in head posture and association with breathing mode and head posture.

Resumo Introdução: A deformidade dentofacial (DDF) e o modo respiratório podem alterar a postura de cabeça. Entretanto as modificações da postura de cabeça após a cirurgia ortognática são controversas e não foram encontrados estudos que apontassem relação entre a postura de cabeça e o modo respiratório em adultos com DDF. Objetivo: Identificar as principais alterações na postura de cabeça em adultos jovens com DDF, verificar se a cirurgia ortognática altera o modo respiratório e a postura de cabeça e se o modo respiratório está associado com a postura de cabeça. Métodos: Foram avaliados 25 jovens adultos, os quais foram divididos no grupo deformidade dentofacial (DDF; n = 15; x̅ = 28 anos) e grupo controle com harmonia dentofacial (GC; n = 10; equilibrados por gênero e idade com o grupo de estudo). O modo respiratório foi analisado de acordo com o protocolo de avaliação miofuncional orofacial e a postura de cabeça foi avaliada por meio da biofotogrametria. Para o grupo DDF, as avaliações foram realizadas antes e após a cirurgia ortognática (pré e pós-DDF). Resultados: Para o grupo DDF, o modo respiratório se modificou após a cirurgia ortognática (p = 0,003), porém com diferença em relação ao GC (p = 0,027). Não houve modificação na postura de cabeça após a cirurgia ortognática, porém observou-se diferença significativa entre os grupos pós-DDF e GC para a inclinação de cabeça (p = 0,017). Não observou-se relação entre o modo respiratório e a postura de cabeça (p > 0,05). Conclusão: Após a cirurgia ortognática, notou-se melhora espontânea da respiração na amostra estudada. Não foi possível verificar modificações na postura de cabeça e associação entre modo respiratório e postura de cabeça.

Assessment of relapse of skeletal open bite treatment in adult patients treated with molar intrusion using temporary anchorage devices and orthognathic surgery - a systematic review / Avaliação da recidiva do tratamento da mordida aberta esquelética em pacientes adultos tratados com intrusão molar utilizando dispositivos de ancoragem temporária e cirurgia ortognática - uma revisão sistemática

Objetivo: O objetivo deste estudo é avaliar sistematicamente as evidências disponíveis para recidiva do tratamento da mordida aberta esquelética usando dispositivos de ancoragem temporária e cirurgia ortognática. Material e Métodos: Cinco bases de dados eletrônicas como MEDLINE, COCHRANE, SCIELO, GOOGLE SCHOLAR, EMBASE foram pesquisadas sistematicamente até junho de 2020. Os estudos de qualidade metodológica foram classificados por meio da Ferramenta de Avaliação de Qualidade do Projeto de Práticas de Saúde Pública Eficazes (EPHPP). Resultados: No total, 1.005 estudos foram identificados para triagem e 6 estudos foram elegíveis. O instrumento de avaliação da qualidade apresentou qualidade moderada para todos os estudos. A correção imediata pós-tratamento da mordida aberta foi melhor nos estudos cirúrgicos do que nos estudos tratados com TADs. Conclusão: A estabilidade dos resultados do tratamento da mordida aberta anterior foi comparável nos casos tratados em ambas as modalidades de tratamento. A recidiva da mordida aberta anterior foi associada a casos em que a sobremordida pós-tratamento foi mínima. A sobremordida parece ser mais estável quando apenas a maxila foi operada do que com cirurgias bimaxilares. A rotação anti-horária da mandíbula com subsequente redução da altura facial anterior foi melhor na correção cirúrgica do que através de TADs (AU)

Objective: The purpose of this study is to systematically assess the available evidence for relapse of skeletal open bite treatment using temporary anchorage devices and orthognathic surgery. Materials and Methods: Five electronic databases such as MEDLINE, COCHRANE, SCIELO, GOOGLE SCHOLAR, EMBASE were systematically searched up to June 2020. Methodological quality studies were graded by means of the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Results: In total, 1005 studies were identified for screening, and 6 studies were eligible. The quality assessment tool showed moderate quality for all the studies. The immediate post treatment correction of open bite was better in the surgical studies than in the studies treated with TADs. Conclusion: Stability of treatment results of anterior openbite was comparable in cases treated in both the treatment modalities. Relapse of anterior open bite was associated with cases in which the posttreatment overbite was minimal. Overbite seems to be more stable when only the maxilla has been operated on than with bi-maxillary surgeries. Counterclockwise rotation of the mandible with subsequent reduction of anterior facial height was better in surgical correction than through TADs. (AU)

Clase III esqueletal ­ cuando todas las estrategias son insuficientes: reporte de un caso clínico / Skeletal class III - when all strategies are insufficient: report of a clinical case

Desde la antigüedad la belleza y la armonía facial han sido objetivos que tanto pintores como escultores, médicos y las personas tratan de lograr. Los rostros han sido estereotipados y es así como las caras proporcionadas tanto en alto como en ancho con perfiles que son rectos o levemente convexos son los que se asocian a bondad, generosidad, personas con luz interior, princesas y son las "buenas de las películas". Pero ¿qué sucede con aquellos rostros cóncavos, con tercios inferiores ya largos o cortos?… a ellos les ha tocado la peor parte, son los malos, los oscuros, los "villanos de las películas". Objetivos La finalidad de este trabajo es acercar a los colegas ortodoncistas una opción de tratamiento en clase III esqueletal, cuando el camuflaje ortodóncico no alcanza para resolver el crecimiento alterado entre el maxilar superior y el maxilar inferior (AU)

Beauty and facial harmony have been, since the beginning of humanity, a target for artists, painters, sculptores, and even people and doctors to accomplish. There is a stereotype of beauty: faces with proportional dimensions both in height and length, with straight profiles or somehow convex are associated with kindness, generosity and inner beauty. We can see this in movies where the heroes, the princesses, the "good guys" are portrayed with these types of faces. And what happens with people with concave faces, long or short inferior thirds? They are doomed to be the evil, the dark and "the villains" (AU)

Discrepancia negativa transversal del maxilar y diferencias cefalométricas laterales según el ancho de la arcada superior / Negative maxillary transverse discrepancy and cephalometric lateral differences according to the width of upper arch

Introduction: Negative maxillary transverse discrepancy is not exclusive to narrow upper arch. The transverse discrepancy due to maxillary deficiency is well described, but this is not the case when the maxilla displays adequate dimensions and the origin of the problem is an excess of mandibular width. Objective: To describe the cephalometric characteristics of negative maxillary transverse discrepancy present in narrow upper arches with those of normal or increased width. Methods: An observational and cross-sectional study was carried out in records of patients with negative maxillary transverse discrepancy. The cases referred to the maxillofacial surgery department at Hospital Clínico Quirúrgico "Hermanos Ameijeiras" between January 2016 and January 2020 were selected. The initial study models were measured and two groups were formed: those with a distance between central fossae of 16 to 26, less than 47 mm and the other with equal or greater values. Lateral cephalometric analysis of Ricketts, McNamara, Björk & Jarabak, Burstone and soft profile were performed on the initial teleradiographs. Using the Mann Whitney U test of independent samples, measurements with statistically significant differences between both groups were selected. (p <0.05). Results: Significant differences were found regarding the cranial-mandibular relationship, mandibular anatomy, maxillo-mandibular relationship and occlusal relationship. The most important differences observed in each group were respectively: S-Ar / Ar-Go ratio (p = 0.033), mandibular body length (p = 0.01), mandibular-maxillary difference (p = 0.003) and overjet (p = 0.043). Conclusions: In the studied patients, negative maxillary transverse discrepancy has the same probability of presenting a wide or in norm upper arch, as well as a narrow arch. In the first case, it is more likely to find jaws with increased body length, a skeletal class III pattern and a concave profile; in the second case, the tendency is to present small jaws with increased articular angle and dental overjet(AU)

Introducción: La discrepancia negativa transversal del maxilar no es exclusiva de una arcada superior angosta. La discrepancia transversal por deficiencia maxilar está bien descrita, pero no ocurre así cuando el maxilar se presenta con dimensiones adecuadas y el origen del problema es un exceso del ancho mandibular. Objetivo: Describir las diferencias cefalométricas de la discrepancia negativa transversal del maxilar que presentan arcadas superiores estrechas con aquellas de ancho normal o incrementado. Métodos: Se realizó un estudio observacional, de corte transversal, en expedientes de pacientes con discrepancia negativa transversal del maxilar. Se seleccionaron los casos que acudieron entre enero del 2016 y enero del 2020 a la consulta de cirugía maxilofacial del Hospital Clínico Quirúrgico "Hermanos Ameijeiras". Se midieron los modelos de estudio iniciales y se conformaron dos grupos: aquellos con distancia entre fosas centrales de 16-26, menor de 47 mm y el otro con valores iguales o superiores. Se realizaron análisis cefalométricos laterales en las telerradiografías iniciales de Ricketts, McNamara, Björk & Jarabak, Burstone y perfil blando. Por medio de la prueba U de Mann Whitney de muestras independientes, se seleccionaron las mediciones con diferencias estadísticas significativas entre ambos grupos (p < 0.05). Resultados: Se encontraron diferencias significativas concernientes a la relación cráneo mandibular, anatomía mandibular, relación máxilo mandibular y relación oclusal. Las diferencias observadas más importantes de cada grupo fueron respectivamente: relación S-Ar/Ar-Go (p = 0,033), longitud del cuerpo mandibular (p = 0,01), diferencia mandibular-maxilar (p = 0,003) y resalte (p = 0,043). Conclusiones: En los pacientes estudiados, las discrepancias negativas transversales tienen la misma probabilidad de presentarse con la arcada superior ancha o en norma, que angosta. En los primeros es más probable encontrar mandíbulas con longitud del cuerpo incrementada, patrón de clase III esquelética y perfil cóncavo; en los segundos, la tendencia es a presentar mandíbulas pequeñas con ángulo articular y resalte dentario aumentados(AU)

Fenestration and dehiscence frequency in maxillary teeth with apical periodontitis: a CBCT study / Frecuencia de dehiscencias y fenestraciones en dientes maxilares con periodontitis apical: un estudio con TCHC

ABSTRACT Introduction: to determine the frequency of fenestration and dehiscence bone defects present in maxillary teeth with apical periodontitis, mainly in teeth with endodontic treatment, as they are frequently cause of nonspecific symptoms after treatment. Methods: 1201 Maxillary Cone Beam Computed Tomography (CBCT) exams were analyzed and 803 teeth with apical periodontitis were selected. Results: of the teeth with apical periodontitis, 142 had a fenestration defect (18%) of which 105 teeth (74%) were endodontically treated. The highest frequency was observed in premolars, with no statistical differences between groups. Dehiscence defect was found in 139 teeth (17%) out of which 90 (65%) were endodontically treated. The highest frequency was observed in molars, with statistical differences in relation to other tooth types (p< 0.001). Conclusion: an important number of teeth with apical periodontitis present dehiscence or fenestration bone defects, especially in teeth with root canal treatment.

Resumen Introducción: determinar la frecuencia de fenestraciones y dehiscencias presentes en dientes maxilares con periodontitis apical, principalmente en dientes con tratamiento de endodoncia, pues frecuentemente son causa de síntomas inespecíficos después del tratamiento. Métodos: se examinaron y analizaron 1201 tomografías computarizadas de haz cónico (TCHC), y se seleccionaron 803 dientes con periodontitis apical. Resultados: de los dientes con periodontitis apical, 142 presentaban fenestración (18%), de los cuales, 105 dientes (74%) estaban tratados endodónticamente. La mayor frecuencia fue observada en premolares, sin diferencias estadísticas entre los grupos. La dehiscencia fue encontrada en 139 dientes (17%), de los cuales 90 (65%) estaban tratados endodónticamente. La mayor frecuencia fue encontrada en molares con diferencia estadísticas en relación con los otros tipos de dientes (p<0,001). Conclusión: un importante número de dientes con periodontitis apical presentan fenestraciones y dehiscencias, especialmente en dientes con tratamiento de canales radiculares.

La maloclusión clase III esquelética grave mediante abordaje primario de cirugía ortognática: informe de caso / Severe skeletal class III malocclusion by surgery-first orthognathic approach: a case report

Class III malocclusion is a relevant public health problem. The management of severe skeletal class III malocclusion in non-growing patients requires properly planned and well-executed orthognathic surgery by a team of at least an orthodontist and a maxillofacial surgeon. For these cases, there are two approaches to the surgery. One of them is the conventional three-stage method, which includes preoperative orthodontic treatment, orthognathic surgery, and postoperative orthodontic treatment. The other is the surgery-first orthognathic approach, which is performed without pre-surgical orthodontic treatment and should present some advantages compared to the conventional technique. However, at present, evidence on the management of class III malocclusion still needs to be expanded. In this paper, we present the management of a case of severe skeletal class III malocclusion by surgery-first orthodontic approach, based on the experience of the Tamil Nadu Government Dental College and Hospital, Chennai, India.

La maloclusión clase III es un problema de salud pública importante. El tratamiento de la maloclusión clase III esquelética grave en pacientes que no están en crecimiento, requiere una cirugía ortognática planificada de forma apropiada y bien ejecutada, por un equipo de al menos un ortodoncista y un cirujano maxilofacial. Para estos casos, existen dos enfoques para la cirugía: el método convencional de tres etapas, que incluye tratamiento de ortodoncia preoperatorio, cirugía ortognática y tratamiento de ortodoncia posoperatorio; y el abordaje primario de cirugía ortognática, que se realiza sin tratamiento de ortodoncia prequirúrgico y debe presentar algunas ventajas en comparación con la técnica convencional. Sin embargo, en la actualidad, las pruebas sobre el abordaje de la maloclusión clase III aún deben ampliarse. En este artículo, presentamos el abordaje de un caso de maloclusión clase III esquelética grave mediante el abordaje inicial con cirugía ortognática, basado en la experiencia del Hospital y Colegio Odontológico del Gobierno de Tamil Nadu, Chennai, India.

Individuals requiring orthognathic surgery have more depression and pain than controls

Abstract The objective of this study was to evaluate if individuals with dentofacial deformities (DFD) who require orthognathic surgery are affected more by depression and pain. A case-control study was performed with 195 individuals. In the DFD group, 145 individuals with Class II and III malocclusion requiring orthognathic surgery were selected. The control group was composed of 50 individuals with no DFD. All patients were diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Data were analyzed with a significance level of 0.05. The DFD group more often presented severe depression (p = 0.020) and chronic pain (p = 0.017). They also presented higher prevalence of Nonspecific Physical Symptoms Including Pain (P = 0.002) and Nonspecific Physical Symptoms Excluding Pain (p = 0.002). Concerning TMD symptoms, the DFD group had more myofascial (p = 0.002) and articular pain (p = 0.041). Therefore, the results of this study suggest that depression and pain are more common in individuals with DFD requiring orthognathic surgery compared with individuals without DFD.

Early recovery after surgery protocol in orthognathic surgery: a randomized, blind clinical study

Abstract A randomized, blind and prospective clinical trial was conducted to compare two clinical rehabilitation protocols in patients submitted to orthognathic surgery, during the first 60 days after surgery. Pain, edema, mandibular movement, masticatory efficiency and quality of life were evaluated. Nineteen (19) patients were separated into control and experimental groups. The control group consisted of 10 patients followed by oral and maxillofacial surgeons and submitted to a rehabilitation protocol that involved active and passive mouth opening exercises. The experimental group had 9 patients and followed the surgeons' protocol, in addition to an Early Recovery After Surgery (ERAS) protocol performed by speech therapists, and involving specific motricity exercises and lymphatic drainage. The Student's t-test was applied to compare the results, and the Fisher's exact test of independence, to analyze the quality of life and the masticatory efficiency variables. The statistical significance was set at 5% (p < 0.05) for all the tests. The results showed that the ERAS protocol made a positive difference in pain perception in the first 14 days. However, it did not improve the other variables. Although many variables showed no significant difference, it was concluded that the surgeons can delegate patient rehabilitation to qualified professionals, so that they can optimize their postoperative clinical time.

Cephalometric for Orthognathic Surgery (COGS) Analysis for Saudi Population

ABSTRACT Objective: To establish the cephalometric (Ceph.) norm by Ceph. for orthognathic surgery (COGS) analysis for Saudi population. Material and Methods: 500 adult Saudi samples (250 males and 250 females) with the age range of 18-30 years old were selected for this study. The selections of samples were based on a normal occlusal relationship, no history of facial trauma and no previous orthodontic treatment. Lateral Ceph. radiographs were tracing by CASSOS software and analyzed by SPSS software according to COGS analysis. Results: Significant differences were showed between the Saudi males and females on most of the Ceph. parameters. The Saudi males had a convex facial profile with chin prominent and more bimaxillary protrusion, upper and lower lip protrusion than the Saudi females. Conclusion: This study evaluated the craniofacial morphological difference between the male and the female population in Saudi Arabia by using COGS analysis. The finding of this study will help for better diagnosis of orthodontic and orthognathic surgical treatment planning and identify the morphological facial characteristics of Saudi patients.

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.

Comparing Outcomes of Airway Changes and Risk of Sleep Apnea after Bimaxillary Orthognathic Surgery and Mandibular Setback Surgery in Patients with Skeletal Class III Malocclusion: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To compare the airway changes and risks of sleep apnea after the bimaxillary orthognathic surgery and mandibular setback surgery in the growing patients with skeletal Class III malocclusion. Material and Methods: MEDLINE, PubMed, Cochrane Library, Embase, ISI, Google scholar have been utilized as the electronic databases for performing systematic literature between 2010 to August 2020. The quality of the included studies has been assessed using MINORS. Meta-analysis was performed using Stata 16 software. Results: In electronic searches, a total of 218 potentially relevant abstracts and topics have been found. Finally, 23 papers met the criteria defined for inclusion in this systematic review. The mean difference of upper airway total volume changes between before and after surgery was (MD = 1.86 cm3 95% CI 0.61 cm3-3.11 cm3; p= 0.00) among 14 studies. This result showed that after Mandibular Setback Surgery, there was a statistically significant decrease in the upper airway volume. Conclusion: Class III Patients who undergo bimaxillary surgery show no other significant difference in airways volume after surgery than patients in Class III who undergo mandibular setback alone.

Three-dimensional pharyngeal airway space changes after bimaxillary advancement

ABSTRACT Introduction: The probability of improvement in the upper airway space (UAS) with orthognathic surgery should be considered during the surgical-orthodontic treatment decision, providing not only an esthetic, but also a functional benefit for the patient. Objective: The purpose of this study was to evaluate the 3D changes in the upper airway space after maxillomandibular advancement surgery (MMA). Methods: A retrospective analysis of 56 patients, 21 male and 35 female, with a mean age of 35.8 ± 10.7 years, who underwent MMA was performed. Pre- and postoperative cone-beam computed tomography scans (CBCT) were obtained for each patient, and the changes in the UAS were compared using Dolphin Imaging 11.7 software. Two parameters of the pharyngeal airway space (PAS) were measured: airway volume (AV) and minimum axial area (MAA). Paired t-test was used to compare the data between T0 and T1, at 5% significance level. Results: There was a statistically significant increase in the UAS. Bimaxillary advancement surgery increased the AV and the MAA, on average, by 73.6 ± 74.75% and 113.5 ± 123.87%, respectively. Conclusion: MMA surgery tends to cause significant increase in the UAS; however, this increase is largely variable.

RESUMO Introdução: A probabilidade de melhoria do espaço aéreo superior (EAS) com cirurgia ortognática deve ser considerada durante a decisão do tratamento ortodôntico-cirúrgico, proporcionando não somente um benefício estético, mas também funcional, para o paciente. Objetivo: O objetivo do presente estudo foi avaliar as alterações 3D no espaço das vias aéreas superiores após a cirurgia de avanço maxilomandibular (AMM). Métodos: Foi realizada uma análise retrospectiva de 56 pacientes, 21 homens e 35 mulheres, com média de idade de 35,8 ± 10,7 anos, submetidos a AMM. Foram obtidas tomografias computadorizadas de feixe cônico (TCFC) pré- e pós-operatórias para cada paciente, e as alterações no EAS foram comparadas usando o software Dolphin Imaging v. 11.7. Foram medidos dois parâmetros do espaço aéreo faríngeo (EAF): volume das vias aéreas (VVA) e área axial mínima (AAM). Foi utilizado o teste t pareado para comparar os dados entre T0 e T1, com nível de significância de 5%. Resultados: Houve um aumento estatisticamente significativo no EAS. A cirurgia de avanço bimaxilar aumentou o volume das vias aéreas (VVA) e a área axial mínima (AAM) em média 73,6 ± 74,75% e 113,5 ± 123,87%, respectivamente. Conclusão: A cirurgia de AMM tende a causar o aumento significativo do EAS; no entanto, esse aumento é altamente variável.

Orthodontic camouflage as a treatment alternative for skeletal Class III

ABSTRACT Introduction: Skeletal Class III malocclusion is a deformity of complex treatment, with few intervention alternatives, which are further limited in nongrowing patients. In most cases, orthognathic surgery is the ideal treatment for adults, an option often refused by patients. Mild to moderate skeletal Class III malocclusions and acceptable facial esthetics can benefit from a course of treatment in which dental movements are used to compensate for the skeletal discrepancy. Objective: This study aimed to discuss orthodontic camouflage as an option for adult patients with Class III malocclusion, emphasizing its indications, implications and expected results.

RESUMO Introdução: A má oclusão esquelética de Classe III é uma deformidade de difícil tratamento e com poucas alternativas de intervenção, que ficam ainda mais limitadas em pacientes sem crescimento. Na maior parte dos casos, o tratamento ideal para adultos é a cirurgia ortognática, opção muitas vezes recusada pelo paciente. As más oclusões esqueléticas de Classe III leve a moderada e com estética facial aceitável podem se beneficiar de um plano de tratamento no qual movimentações dentárias são realizadas para compensar a discrepância esquelética. Objetivo: O objetivo do presente estudo foi discutir a camuflagem ortodôntica como opção para pacientes adultos com má oclusão de Classe III, ressaltando suas indicações, implicações e resultados esperados.

Severe hypothyroidism after orthognathic surgery: a case report / 华西口腔医学杂志

Hypothyroidism is a common endocrine disease with reduced systemic metabolism, but the initial diagnosis is rare in oral and maxillofacial surgery. Due to the nonspecific symptoms, it is easy to be misdiagnosed and missed diagnosis which results in serious consequences. This paper presents a case of severe hypothyroidism which was characterized by airway obstruction, facial swelling, unexplained anaemia and bipedal edema after orthognathic surgery. With review of relevant literatures, this article discusses the risk factors, symptoms, diagnosis and therapy of hypothyroidism.

Comprehensive correction of maxillofacial bone deformity-consideration and combined application of orthognathic surgery and facial contouring surgery / 华西口腔医学杂志

The maxillofacial skeleton is the basis of the contour of the face. Orthognathic surgery and facial contouring surgery change jaw tissue and affect facial appearance in different manners. Orthognathic surgery is the main method to correct dental and maxillofacial deformities. It changes the shape of the jaw and improves the occlusal relationship by changing the three-dimensional position of the jaw. Facial contouring surgery mainly adopts the method of "bone reduction", which changes the "amount"of the jawbone by cutting a part of the bone tissue to improve the facial appearance, generally without changing oral function. The combined use of orthognathic surgery and facial contouring surgery is becoming increasingly common in clinical practice. This also requires oral and maxillofacial surgeons to have a holistic consideration of the comprehensive correction of maxillofacial bone deformity, and to perform comprehensive analysis of jaw deformities and jaw plastic surgery to achieve the most ideal results. The author's team has been engaged in the clinical work of orthognathic surgery and facial contouring surgery and accumulated rich clinical experience in the comprehensive correction of maxillofacial bone deformity. In this article, the indications, treatment goals, treatment modes, treatment methods, and key points in the surgical operations of comprehensive maxillofacial bone surgery were summarized.

Análise fonoaudiológica na cirurgia ortognática: estudo de caso uma década após procedimento / Speech-Language and Hearing Sciences Analysis in orthognathic surgery: a case study with a ten-year follow up / Análisis fonoaudiológica en la cirugía ortognática: estudio de caso una década de evolución posquirúrgica

Introdução: desproporções esqueléticas são consideradas casos extremos de variação da tipologia facial, caracterizadas por grandes alterações da oclusão associadas a modificações funcionais. O tratamento é orto-cirúrgico, com reconstrução das bases ósseas por meio de cirurgia ortognática. Após essa cirurgia, o acompanhamento fonoaudiológico auxilia o paciente no reconhecimento da nova face e nas readaptações das funcões de respiração, fala, mastigação e deglutição. Objetivo: apresentar relato de caso clínico de cirurgia ortognática, em seguimento longitudinal de 10 anos, por meio de análise das avaliações fonoaudiológicas. Relato do caso: mulher, 26 anos, portadora de deformidade craniofacial do tipo Classe III, prognata, com queixa estética e de mastigação, com indicação de cirurgia ortognática. Foram realizadas cinco avaliações fonoaudiológicas, sendo: a primeira na fase pré-operatória, segunda no 19º dia de pós-operatório, terceira após três meses de reabilitação fonoaudiológica, quarta após quatro meses de manutenção dos resultados obtidos e a quinta após 10 anos da intervenção cirúrgica. Em avaliação pré-cirúrgica foi registrada alteração no padrão miofuncional relacionado às funções de mastigação, deglutição, fala e respiração. Após terapia fonoaudiológica observou-se melhora da musculatura de lábios, bochecha, masseter e postura de língua, bem como na amplitude dos movimentos mandibulares. Em 10 anos observa-se estabilidade nos padrões funcionais de respiração, posicionamento de língua em repouso, organização do padrão da fala, articulação, deglutição, assim como na autoestima da paciente. Considerações finais: o tratamento fonoaudiológico associado à cirurgia ortognática e à ortodontia mostrou evoluções e eficácia, para nesse caso, atingir satisfação da paciente aos novos ajustes do padrão miofuncional.

Introduction: dentofacial deformities are seen as extreme cases of facial typology variation, characterized by major changes in occlusion associated with functional modifications. It requires an ortho-surgical treatment, in which the bone bases are reconstructed through orthognathic surgery. Treatment and monitoring are required after surgery with a Speech-language Pathologist (SLP) in order to assist patients in the recognition of their new faces and in the adjustments of orofacial functional patterns, avoiding negative interferences. Purpose: to report an orthognathic surgery clinical case in a 10-year longitudinal follow-up through the analysis of the SLP assessments. Case report: a prognathous 26-year-old woman with Class III craniofacial deformity, presenting aesthetic and chewing complaints with indication for orthognathic surgery. Five SLP ́s assessments were conducted, as follows: the first one, in the preoperative stage; the second, 19 days after the surgery; the third, after three months of SLP rehabilitation; the fourth, after four months of follow-up as maintenance of the results obtained; and the fifth, ten years after the surgical intervention. In the preoperative assessment, changes were recorded in the myofunctional pattern related to chewing, swallowing, speech and breathing functions. Improvements in the lip, cheek and masseter muscles were reported after SLP therapy, as well as in tongue posture and mandibular range of motion. After 10 years, favorable changes were observed in breathing pattern and tongue posture at rest, organization and stability of speech, articulation, and swallowing patterns, as well as in the patient's self-esteem. Final considerations: the SLP approach associated with orthognathic surgery and orthodontics procedure achieved evolutions and proved to be effective, leading this patient to satisfactory new adjustments of the myofunctional pattern.

Introducción: Desproporciones esqueléticas son consideradas casos extremos de variaciones de la tipología facial, caracterizadas por grandes alteraciones de la oclusión asociadas a las modificaciones funcionales. El tratamiento es echo con ortodoncia y cirugía ortognática, con reconstrucción de las bases óseas y estabilización oclusal. Después de esa cirugía, acompañamiento fonoaudiólogo auxilia el paciente en el reconocimiento facial y en las readaptaciones de las funciones estomatognáticas. Objetivo: Presentar relato de caso clínico de cirugía ortognática, en seguimiento longitudinal de 10 años, por medio de análisis de las evaluaciones fonoaudiológicas. Relato del caso: Mujer, 26 años portadora de deformidad cráneo facial del tipo clase III, prognata, con queja estética y de masticación, con indicación de cirugía ortognática. Fueron realizadas cinco evaluaciones fonoaudiológicas, siendo: la primera en la fase pre-operatorio, segunda en el 19º día de post operatorio, tercera después de tres meses de rehabilitación fonoaudiológica, cuarta después de cuatro meses de manutención de los resultados obtenidos y la quinta después de 10 años de la intervención de cirugía. En la evaluación preoperatorio fue registrada alteración en el patrón miofuncional relacionado a las funciones de masticación, deglución, habla y respiración. Después terapia fonoaudiológica se observó mejora en la musculatura de labios, mejillas, masseter (musculo masetero) y postura de la lengua, bien como en el patrón de oclusión. En 10 años se observa el cambio favorable en el patrón de respiración y posicionamiento de la lengua en reposo, organización y estabilidad del patrón de habla, articulación, deglución, así como en el auto estima de la paciente. Consideraciones Finales:El tratamiento fonoaudiológico asociado a la cirugía ortognática y la ortodoncia mostro evoluciones y eficacia, para en ese caso, alcanzar satisfacción de la paciente a los nuevos ajustes del patrón miofuncional.