Esthetic perception of facial profile changes after extraction and nonextraction Class II treatment

Abstract This retrospective study evaluated facial profile pleasantness determined by two protocols of Class II treatment. The sample comprised facial profile silhouettes obtained retrospectively from the pretreatment (T1) and posttreatment (T2) cephalograms of 60 patients (42 males and 18 females) divided into two groups. One group of 30 patients (mean age of 12.84 years) was treated with the extraction of maxillary first premolars (mean treatment time of 2.7 years), and the other group of 30 patients (mean age of 12.81 years) was treated with a mandibular advancement appliance (Forsus) (mean treatment time of 2.49 years). The facial profile silhouettes (T1 and T2) were randomly distributed in an album containing one patient per sheet. The examiners consisted of 60 orthodontists and 60 lay individuals, who analyzed the profiles in regard to facial pleasantness, using the Likert scale. A comparison between stages T1 and T2 of the two treatment protocols and between the examiners was performed by mixed-design analysis of variance at a significance level of 5%. The results demonstrated a significant difference between T1 and T2 (greater scores for T2 compared to T1), and between lay individuals and orthodontists (orthodontists assigned higher scores), but with no significant difference between the treatment protocols. Both protocols produced positive effects on the facial profile esthetics, from the standpoint of lay individuals and orthodontists.

Protocolo de Tratamento Orto-Cirúrgico da Má Oclusão de Classe II em paciente com Sindrome da Apnéia e/ou Hipoapnéia Obstrutiva do sono: relato de caso / Ortho-surgical treatment protocol for Class II malocclusion in a patient with obstructive sleep apnea and/or hypopnea syndrome: case report

Introdução: A Síndrome de apnéia e/ou hipopnéia obstrutiva do sono (SAHOS) é caracterizada pela obstrução repetida das vias aéreas ou redução da respiração durante o sono. Esta síndrome é causada por colapso faríngeo contra aumento do esforço espiratório durante o sono. A SAHOS leva à deterioração da qualidade do sono associado à queixa de sonolência diurna excessiva e a efeitos desfavoráveis no sistema cardiovascular. Características orofaciais como retrognatismo mandibular e/ou associado a retrognatismo maxilar, má oclusão de Classe II, com ou sem mordida aberta, e diminuição das vias aéreas orofaríngeas fazem parte do seu quadro. Objetivo: Relato do tratamento ortocirúrgico de um paciente com 31 anos de idade com caraterísticas de SAHOS, má oclusão de Classe II, deficiência mandibular, mordida cruzada posterior e aberta anterior, diminuição da altura facial anteroinferior, aprofundamento do sulco mentolabial, pouca exposição do lábio inferior e nítido desequilíbrio facial. Relato e Resultados: Tratamentos não invasivos para SAHOS passam pelos dispositivos de pressão nasal contínua positiva nas vias aéreas ou aparelhos intra-bucais com o objetivo de manter a mandíbula em posição anteriorizada durante o sono. Nos tratamentos invasivos, a cirurgia de avanço mandibular evita a rotação no sentido anti-horário do complexo maxilomandibular com aumento do espaço orofaríngeo das vias aéreas médias e inferiores. Nas situações com grande impacto esquelético dentofacial associado ao grau de obstrução das vias aéreas será necessário um tratamento descompensatório ortocirúrgico, permitindo assim um restabelecimento respiratório e estético da face. Conclusão: O tratamento descompensatório com avanço cirúrgico bimaxilar foi responsável pela correção da má oclusão e aumento do espaço aéreo, contemplando a expectativa respiratória, funcional e estética.

Introduction: Obstructive sleep apnea and/or hypopnea syndrome (OSAHS) is characterized by repeated obstruction of the airway or reduction of breathing during sleep. This syndrome is caused by pharyngeal collapse against increased respiratory effort during sleep. SAHOS leads to deterioration of sleep quality associated with clinical complaints of excessive daytime sleepiness and unfavorable effects on the cardiovascular system. Orofacial features such as mandibular retrognathism and/or associated maxillary retrognathism, Class II malocclusion, with or without open bite and reduction of the oropharyngeal airway characterize this syndrome. Objective: It is reported an orthosurgical treatment of a 31 years old male patient, with OSAHS characteristics, Class II malocclusion, mandibular deficiency, posterior crossbite and anterior open bite, lower anterior facial height decrease, deepening of the labial sulcus, little exposure of the lower lip and unbalanced face. Report and Results: Non-invasive treatments for OSAHS pass through positive continuous nasal pressure devices in the airways or intra-oral appliances in order to maintain the mandible in an anterior position during sleep. In the invasive treatments protocol, mandibular advancement surgery prevents rotation in the anti-clockwise direction of the maxillomandibular complex with an increase in the oropharyngeal space of the middle and lower airways. In cases with great skeletal dentofacial impact associated with the degree of obstruction of the airway will be necessary an ortho-surgical decompensatory treatment, to allow a respiratory and aesthetic restoration of the face. Conclusion: The decompensatory treatment with bimaxillary surgical advancement corrected the malocclusion, increasing the air space contemplating the respiratory, functional and aesthetic expectation.