Guía de atención para pacientes con maloclusión de clase II con dentición permanente en crecimiento activo

Fundamento la maloclusión de clase II presenta la mayor prevalencia entre las alteraciones dentoesqueléticas. Objetivo: proponer una guía de atención para pacientes con maloclusión de clase II con dentición permanente en crecimiento activo. Métodos: se realizó una investigación de innovación tecnológica de enfoque mixto en el Departamento de Ciencias Clínicas de la Facultad de Estomatología de la Universidad de Ciencias Médicas de Villa Clara, en el periodo comprendido entre los años 2020 y 2023. El universo de estudio estuvo constituido por todos los especialistas de Ortodoncia de la provincia de Villa Clara, Sancti Spíritus y Cienfuegos, a partir del cual se realizó un muestreo no probabilístico intencional por criterios y quedó constituida la muestra por 20 especialistas y siete expertos (especialistas de categoría superior) con criterios de inclusión. Resultados: la documentación revisada aportó información valiosa para determinar el estado actual de la atención de la maloclusión de estudio. Los especialistas emitieron diferentes criterios sobre el diagnóstico y tratamiento de la maloclusión de clase II. Los expertos establecieron los elementos invariables para su clasificación. Finalmente se diseñó una guía de atención para los pacientes con maloclusión de clase II con dentición permanente en crecimiento activo, valorada por los especialistas con la categoría de excelente. Conclusiones: la guía propuesta contiene elementos invariables de diagnóstico y pautas de tratamiento con el fin de lograr una atención más integral y eficiente de la maloclusión.

Foundation: Class II malocclusion has the highest prevalence among dentoskeletal disorders. Objective: to propose a care guide for patients with class II malocclusion with actively growing permanent dentition. Method: a mixed approach technological innovation research was carried out in the Clinical Sciences Department from the Stomatology Faculty of the Villa Clara Medical Sciences University, from 2020 to 2023. The studied universe was all the Orthodontic specialists in the Villa Clara province, Sancti Spíritus and Cienfuegos, from which an intentional non-probabilistic sampling was carried out by criteria and the sample was made up of 20 specialists and seven experts (higher category specialists) with criteria of inclusion. Results: The reviewed documentation provided valuable information to determine the current state of care for malocclusion under study. Specialists issued different criteria on the diagnosis and treatment of class II malocclusion. The experts established the invariable elements for their classification. Finally, a care guide was designed for patients with class II malocclusion with actively growing permanent dentition, rated by specialists as excellent. Conclusions: the proposed guide contains invariable diagnostic elements and treatment guidelines in order to achieve more comprehensive and efficient malocclusion care.

Evaluation of the maximum tongue and lip pressure in individuals with Class I, II, or III Angle malocclusions and different facial types / Avaliação da pressão máxima da língua e dos lábios em indivíduos com má oclusão Classe I, II e III de Angle e diferentes padrões faciais

ABSTRACT Purpose To compare the maximum anterior and posterior tongue pressure, tongue endurance, and lip pressure in Class I, II, and III malocclusions and different facial types. Methods A cross-sectional observational analytical study was carried out in 55 individuals (29 men and 26 women) aged between 18 and 55 years. The participants were divided into groups according to Angle malocclusion (Class I, II, and III) and facial type. The maximum anterior and posterior tongue pressure, tongue endurance, and maximum lip pressure were measured using the IOPI (Iowa Oral Performance Instrument). To determine the facial type, the cephalometric analysis was accomplished using Ricketts VERT analysis as a reference. Results There was no statistically significant difference when comparing the maximum pressure of the anterior and posterior regions of the tongue, the maximum pressure of the lips, or the endurance of the tongue in the different Angle malocclusion types. Maximum posterior tongue pressure was lower in vertical individuals than in mesofacial individuals. Conclusion Tongue and lips pressure, as well as tongue endurance in adults was not associated with the type of malocclusion. However, there is an association between facial type and the posterior pressure of the tongue.

RESUMO Objetivo comparar a pressão máxima anterior e posterior da língua, a resistência da língua e a pressão labial em indivíduos com más oclusões Classe I, II e III e diferentes tipos faciais. Método foi realizado um estudo analítico observacional transversal em 55 indivíduos (29 homens e 26 mulheres) com idades entre 18 e 55 anos. Os participantes foram divididos em grupos de acordo com a classificação de Angle para má oclusão (Classe I, II e III) e tipo facial. A pressão máxima anterior e posterior da língua, a resistência da língua e a pressão máxima dos lábios foram medidas usando o IOPI (Iowa Oral Performance Instrument). Para determinar o tipo facial, a análise cefalométrica foi realizada utilizando como referência a análise Ricketts VERT. Resultados não houve diferença estatisticamente significativa ao comparar a pressão máxima das regiões anterior e posterior da língua, a pressão máxima dos lábios ou a resistência da língua nos diferentes tipos de má oclusão. A pressão máxima posterior da língua foi menor em indivíduos com tipo facial vertical do que nos indivíduos mesofaciais. Conclusão a pressão de língua e lábios, assim como a resistência de língua em adultos não foi associada ao tipo de má oclusão. No entanto, existe uma associação entre o tipo facial e a pressão posterior da língua.

Orthodontic biomechanics with intermaxillary elastics

ABSTRACT Introduction: Intermaxillary elastics are orthodontic resources widely used in various malocclusions. Their main advantages are low cost, easy insertion and removal by patients, and application versatility. As main disadvantages, we can highlight the need for cooperation from patients and the side effects normally present in treatments with this resource. Knowledge of the biomechanics involved in the use of intermaxillary elastics is essential to take full advantage of the desired effects and avoid unwanted effects in their use. Objective: Therefore, the objective of this article is to describe the anchorage preparation, connection methods, time and force of use, and side effects involved in the use of intermaxillary elastics for the treatment of anteroposterior, vertical and transverse problems. For that, clinical cases and biomechanics schemes will be presented, in which all these details will be described.

RESUMO Introdução: Os elásticos intermaxilares são recursos ortodônticos amplamente utilizados nas diversas más oclusões. Possuem como principais vantagens o baixo custo, fácil inserção e remoção pelos pacientes, e versatilidade de aplicação. Como desvantagens podemos destacar a necessidade de cooperação dos pacientes e os efeitos colaterais normalmente presentes nos tratamentos com esse recurso. O conhecimento da biomecânica envolvida no uso dos elásticos intermaxilares é fundamental para se obter o máximo de efeitos desejados e evitar os efeitos indesejados na sua utilização. Objetivo: O objetivo desse artigo é descrever o preparo da ancoragem, as formas de conexão, o tempo e a força de uso, além dos efeitos colaterais envolvidos na utilização dos elásticos intermaxilares para tratamento de problemas anteroposteriores, verticais e transversais. Para isso, serão apresentados casos clínicos e esquemas de biomecânica em que todos esses detalhes serão descritos.

Orthodontists' preferences in the use and timing of appliances for the correction of malocclusions in growing patients / Preferencias de los ortodoncistas en el uso y momento oportuno de uso de aparatos para la corrección de maloclusiones en pacientes en crecimiento

Objective: To evaluate orthodontists' preferences in the use and timing of appliances for the correction of Class II and Class III malocclusions in growing patients and the sociodemographic factors that influence these preferences. Material and Methods: Active members of the Colombian Orthodontics Society (SCO) were invited to complete a previously validated survey on the use of Class II and Class III correctors in growing patients. Results: 180 orthodontists responded (80 male, 100 female). The appliances used most frequently in the treatment of Class II malocclusion were Planas indirect tracks (32.78%) and Twin-blocks (30.56%). Facemasks (62.22%) and Progenie plates (25%) were the most prevalent appliances used in the treatment of Class III malocclusions. Regarding treatment timing, 52% of the orthodontists stated that Class II malocclusions must be treated during late mixed dentition or early permanent dentition, 42% stated that treatment for Class III malocclusions should occur during early mixed dentition. Appliance use and treatment timing were significantly associated with sex (p= 0.034), years of practice (p= 0.025), and area of work (private clinics or public institutions), (p= 0.039). Conclusion: Twin-blocks and Facemask appliances were the preferred appliances for Class II and Class III treatment, respectively, in growing patients. Most of the orthodontists believed that Class II malocclusions must be treated during late mixed dentition and that Class III malocclusions must be treated during early mixed dentition. Sociodemographic variables are related factors that influence orthodontists' preferences in the use of these appliances.

Objetivo: Evaluar las preferencias de los ortodoncistas en el uso y momento oportuno de uso de aparatología para la corrección de maloclusiones Clase II y Clase III en pacientes en crecimiento y los factores sociodemográficos que influyen en estas preferencias. Material y Métodos: Se invitó a miembros activos de la Sociedad Colombiana de Ortodoncia (SCO) a completar una encuesta previamente validada, sobre el uso de correctores para Clase II y Clase III en pacientes en crecimiento. Resultados: Respondieron un total de 180 ortodoncistas (80 hombres, 100 mujeres). La aparatología más utilizada en el tratamiento de las maloclusiones de Clase II fueron pistas indirectas de Planas (32,78%) y bloques gemelos (30,56%). La máscara facial (62,22%) y las placas progenie (25%) fueron los aparatos más utilizados en el tratamiento de las maloclusiones de Clase III. En cuanto al momento oportuno del tratamiento, el 52% de los ortodoncistas afirmó que las maloclusiones de Clase II deben tratarse durante la dentición mixta tardía o la dentición permanente temprana, el 42% afirmó que el tratamiento para las maloclusiones de Clase III debe ocurrir durante la dentición mixta temprana. El uso de aparatos y el momento oportuno del tratamiento se asociaron significativamente con el sexo (p= 0,034), los años de práctica (p= 0,025) y el área de trabajo (clínicas privadas o instituciones públicas) (p= 0,039). Conclusión: Los aparatos bloques gemelos y la máscara facial fueron los preferidos para el tratamiento de Clase II y Clase III, respectivamente, en pacientes en crecimiento. La mayoría de los ortodoncistas consideran que las maloclusiones de Clase II deben tratarse durante la dentición mixta tardía y que las maloclusiones de Clase III deben tratarse durante la dentición mixta temprana. Las variables sociodemográficas son factores relacionados que influyen en las preferencias de los ortodoncistas en el uso de estos aparatos.

Cambios en incisivos y su relación con el punto A y el ángulo nasolabial en pacientes Clase II división 2 tratados con y sin extracciones en el Centro Dental Docente UPCH / Changes in incisors and their relationship with point A and nasolabial angle in Class II division 2 patients treated with and without extractions at the UPCH Teaching Dental Center

RESUMEN Antecedentes : Diversos estudios describen las características de la maloclusión clase II-2, sin embargo, son escasos los estudios que evalúan las repercusiones del tratamiento sobre tejidos blandos y esqueléticos. Objetivo : Evaluar los cambios post tratamiento en inclinación y posición incisiva y su relación con el ángulo nasolabial (ANL) y el punto A (PA) en pacientes Clase II división 2, con y sin extracciones en casos de la especialidad de Ortodoncia de la Universidad Peruana Cayetano Heredia. Material y métodos: se realizaron trazados manuales y mediciones de 62 radiografías cefalométricas laterales (31 pre y 31 post-tratamiento), de pacientes con maloclusión de Clase II división 2. El análisis estadístico se realizó con SPSS 21.0 para Windows. Resultados : Se observan proinclinación y protrusión incisiva en todos los pacientes. En pacientes con exodoncias el ANL presentó cambios no significativos, pero correlaciones significativas: cuando aumentó la inclinación incisiva inferior disminuyó el ANL; cuando aumentó el ANL, aumentó el ángulo interincisal (AII). El punto A (PA) experimentó cambios y correlaciones, pero no significativas. En pacientes sin exodoncias no se encontraron correlaciones ni cambios significativos en PA ni en ANL. Las mujeres tratadas sin exodoncia no presentaron cambios significativos, en los hombres los cambios más significativos fueron la inclinación y protrusión incisiva inferior. En los casos con exodoncias en hombres fue el AII; y en las mujeres el AII y el ángulo incisivo superior/ plano palatino. Conclusiones: Existe una relación entre los cambios que se producen en los incisivos y el ANL y PA, aunque la mayoría no son estadísticamente significativos.

ABSTRACT Background : There are studies evaluating cephalometric parameters in Class II division 2 patients. There are no similar investigations in Peru. Objective : To evaluate post-treatment changes in incisor inclination and position and their relationship with the nasolabial angle (ANL) and point A (PA) in Class II division 2 patients, with and without extractions in cases of the Orthodontic specialty program of the Universidad Peruana Cayetano Heredia. Material and methods : manual tracing and measurements of 62 lateral cephalometric radiographs (31 pre and 31 post-treatment) were performed, of patients with Malocclusion Class II division 2. Statistical analysis was performed with SPSS 21.0 for Windows. Results : There was proinclination and incisive protrusion in all patients. In patients with extractions, the ANL presented non-significant changes, but significant correlations: when the lower incisor inclination increased, the ANL decreased; when ANL increased, the interincisal angle (AII) increased. Point A (PA) experienced changes and correlations, but not significant. In patients without extractions, no correlations or significant changes were found in BP or ANL. Women treated without extraction did not show significant changes, in men the most significant changes were lower incisor inclination and protrusion. In the cases with extractions in men it was AII; and in women the AII and the upper incisor angle / palatal plane. Conclusions: There is a relationship between the changes that occur in the incisors and the ANL and PA, although most are not statistically significant.

Utilización del botón de Nance modificado para la propulsión mandibular / Utilization of the modified Nance button for mandibular propulsion

RESUMEN Introducción: En sus inicios la mayoría de los aparatos funcionales fueron removibles, pero cada día más se incrementan los fijos. Su combinación puede incrementar la eficacia en el tratamiento del retrognatimo mandibular. Objetivo: Presentar los resultados del tratamiento con el botón de Nance modificado en una paciente con retrognatismo mandibular. Caso clínico: Paciente femenina de 13 años de edad, que presenta perfil convexo, disfunción neuromuscular, dentición permanente en ambos maxilares con presencia de ligero apiñamiento anterior, relación molar bilateral de distoclusión de ½ unidad, resalte y sobrepase incisivos de 6 mm, mala relación intermaxilar causada por retrognatismo de la mandíbula y escaso remanente de crecimiento mandibular activo. La primera etapa del tratamiento, incluyó psicoterapia, mioterapia y avance mandibular con un aparato funcional fijo (botón de Nance modificado para la propulsión mandibular). A los nueve meses de iniciar el tratamiento se comprobó el cambio en las relaciones intermaxilares en sentido antero-posterior, con disminución del ángulo ANB hasta 20 e incremento del SNB a 78, como reflejo de una buena relación de las bases ósea por crecimiento mandibular. Conclusiones: El tratamiento realizado a la paciente con el botón de Nance modificado para la propulsión mandibular, permitió la obtención de relaciones intermaxilares favorables.

ABSTRACT Introduction: In the beginning, most of the functional appliances were removable, but the fixed ones are increasing every day. Their combination can increase the effectiveness in the treatment of mandibular retrognathymus. Objective: To present the results of the treatment of a patient with mandibular retrognathism treated with the modified Nance button. Case report: A 13-year-old female patient with convex profile, neuromuscular dysfunction, permanent dentition in both jaws with the presence of slight anterior crowding, bilateral distoclusion molar ratio of ½ unit, incisor protrusion and overhang of 6 mm, poor intermaxillary relationship caused by retrognathism of the mandible and little remnant of active mandibular growth. The first stage of treatment included psychotherapy, myotherapy and mandibular advancement with a fixed functional appliance (modified Nance button for mandibular propulsion). Nine months after starting the treatment, the change in the intermaxillary relationships in the anteroposterior direction was verified, with a decrease in the ANB angle to 20 and an increase in the SNB to 78, as a reflection of a good relationship of the bone bases due to mandibular growth. Conclusions: One year after treatment with the modified Nance button for mandibular propulsion, a correct relationship of the patient's bone bases was achieved.

Evaluation of the clinical effectiveness of miniscrews in class i and ii malocclusion patients: a systematic review and meta-analysis

Aim: The present systematic review and meta-analysis aimed to evaluate the clinical effectiveness of miniscrews in Class I and II Malocclusion Patients. Methods: From electronic databases, between 2010 and 2020, PubMed, Embase, Cochrane Library, ISI were used to conduct systematic literature. Two reviewers extracted data blindly and independently from the abstract and full text of the studies they used for data extraction. The mean differences between the two groups (miniscrews vs. conventional anchorage) with a 95 % confidence interval (CI), the Inverse-variance method, and the fixed-effect model were calculated. The Meta-analysis was evaluated using the statistical software Stata/MP v.16 (The fastest version of Stata). Results: A total of 186 potentially relevant titles and abstracts were found during the electronic and manual search. Finally, the inclusion criteria required for this systematic review were met by a total of seven publications. The mean difference of molar mesiodistal movement among seven studies and heterogeneity was -0.53 mm (MD, -0.53 95 % CI -0.69, -0.38. P= 0.00) (I2 = 96.52 %). This result showed maximum reinforcement in miniscrews with fewer mesial movements. Conclusion: The result of the current systematic review and meta-analysis shows that miniscrews in patients with class II and I malocclusion help maintain better anchorage preservation than traditional anchorage devices

Differential Diagnosis of Skeletal Class II: Orthodontic-Surgical Approach with Surgery First / Diagnóstico Diferencial da Classe II esquelética: Abordagem Ortodôntico-Cirúrgica com Benefício Antecipado

Abstract Orthodontic-surgical treatment with the "Surgery First Approach" provides immediate facial aesthetic improvements and significantly reduces the patient's orthodontic treatment time, avoiding the transient worsening of the facial profile due to dental decompensation that occurs in surgical cases. Thus, this clinical case describes the retreatment of a 22-year-old female leukoderma patient, whose main complaint was related to the proclination of upper and lower incisors. The patient used a mio-relaxing plate for 30 days, which evidenced the skeletal mandibular deficiency and the ½ bilateral Class II malocclusion. Orthognathic surgery first approach associated with the extraction of the 4 premolars was chosen considering the patient's aesthetic demand. The use of a mio-relaxing plate in the diagnostic stage was essential for the real diagnosis of mandibular deficiency and the technique employed made it possible to conclude the treatment avoiding aesthetic commitment, with excellent results. (AU)

Resumo O tratamento ortodôntico-cirúrgico por meio do benefício antecipado proporciona melhorias estéticas faciais imediatas e reduz de maneira significativa o tempo de tratamento ortodôntico do paciente, evitando a piora transitória do perfil facial devido à descompensação dentária que ocorre em casos cirúrgicos. Assim, este caso clínico descreve o retratamento de uma paciente com 22 anos de idade, leucoderma, sexo feminino, que apresentava queixa principal relacionada à inclinação vestibular dos dentes anteriores. Após uso de placa miorrelaxante por 30 dias, verificou-se a presença de Classe II esquelética com deficiência mandibular e ½ Classe II dentária bilateral. Considerando a demanda estética da paciente, optou-se pela abordagem ortodôntico-cirúrgica com Benefício Antecipado associada à extração de 4 pré-molares para correção da inclinação dentária anterior. O uso da placa miorrelaxante foi fundamental para o diagnóstico real da deficiência mandibular e a técnica empregada possibilitou concluir o tratamento evitando o comprometimento estético pré-cirúrgico, com obtenção de excelentes resultados. (AU)

Attractiveness of the facial profile: comparison of Class II patients treated with Twin Force® or intermaxillary elastics

ABSTRACT Objective: To compare the facial profile attractiveness of Class II patients treated with Twin Force® or intermaxillary elastics. Methods: Sample comprised 47 Class II patients divided into two groups: G1) TWIN FORCE - 25 patients treated with fixed appliances and Twin Force® fixed functional appliance (mean initial age was 17.91 ± 7.13 years, mean final age was 20.45 ± 7.18 years, and mean treatment time was 2.53 ± 0.83 years); G2) ELASTICS - 22 patients treated with fixed appliances and Class II intermaxillary elastics (mean initial age was 15.87 ± 5.64 years, mean final age was 18.63 ± 5.79 years and mean treatment time was 2.75 ± 0.60 years). Lateral cephalograms from pretreatment and posttreatment were used. Cephalometric variables were measured and silhouettes of facial profile were constructed and evaluated by 48 laypeople and 63 orthodontists, rating the attractiveness from 0 (most unattractive profile) to 10 (most attractive profile). Intergroup comparisons were performed with Mann-Whitney and independent t-tests. Results: At pretreatment, facial profile of the Twin Force® group was less attractive than the Elastics group. Treatment with Twin Force® or Class II elastics resulted in similar facial profile attractiveness, but the facial convexity was more reduced in the Twin Force® group. Orthodontists were more critical than laypeople. Conclusions: Treatment with Twin Force® or Class II elastics produced similar facial profile attractiveness at posttreatment. Profile attractiveness was reduced with treatment in the elastic group, and improved in the Twin Force® group. Facial convexity was more reduced with treatment in the Twin Force® group.

RESUMO Objetivo: Comparar a atratividade do perfil facial em pacientes Classe II tratados com Twin Force® ou elásticos intermaxilares. Métodos: A amostra foi composta por 47 pacientes Classe II divididos em dois grupos: G1 - Twin Force® (25 pacientes tratados com aparelhos fixos e o aparelho funcional Twin Force®; idade inicial média de 17,91 ± 7,13 anos, idade final média de 20,45 ± 7,18 anos, e tempo médio de tratamento de 2,53 ± 0,83 anos); G2 - Elásticos (22 pacientes tratados com aparelhos fixos e elásticos intermaxilares de Classe II, idade inicial média de 15,87 ± 5,64 anos, idade final média de 18,63 ± 5,79 anos, e tempo médio de tratamento de 2,75 ± 0,60 anos). Foram usadas telerradiografias laterais pré- e pós-tratamento. As variáveis cefalométricas foram mensuradas, e silhuetas do perfil facial foram construídas e avaliadas por 48 leigos e 63 ortodontistas, que pontuaram a atratividade entre 0 (perfil menos atraente) e 10 (perfil mais atraente). As comparações intergrupos foram realizadas com os testes Mann-Whitney e t de Student para amostras independentes. Resultados: Na fase pré-tratamento, o perfil facial no grupo Twin Force® foi menos atrativo do que no grupo Elásticos. Os tratamentos com o Twin Force® ou com Elásticos de Classe II resultaram em atratividade semelhante do perfil facial, mas a convexidade facial foi mais reduzida no grupo Twin Force®. Os ortodontistas foram mais críticos do que os leigos. Conclusões: Apesar de os tratamentos com o Twin Force® ou com Elásticos de Classe II terem resultado em atratividade semelhante do perfil facial após o tratamento, a atratividade do perfil foi reduzida com o tratamento no grupo Elásticos e melhorou no grupo Twin Force®. A convexidade facial foi mais reduzida com o tratamento no grupo Twin Force®.

Dolphin software accuracy in soft tissue facial profile prediction of Class II patients in orthognathic surgery / Precisão de software Dolphin na predição do perfil facial de tecidos moles de pacientes Classe II submetidos a cirurgia ortognática

ABSTRACT Objective: The present study aimed to analyze the accuracy of the Dolphin Imaging 11.9® computer program in the surgical prediction of the soft tissue facial profile. Methods: The investigators designed and implemented a retrospective study. It was used a sample of 55 patients, being 14 males and 41 females, aged from 19 to 55 years old. All patients were subjected to surgery orthognathic bimaxillary combined with mentoplasty, in Class II facial profile - Angle. Patients' actual results were compared to the obtained up to a year and a half after the surgery procedure. The study was delineated in three phases. In the first phase, cephalometric preoperative radiographs were performed; in the second phase the postoperative cephalometries were made; in the third phase, the measurements of the soft profile of the virtual analysis were compared with the real post-surgical profile. The data was collected and subjected to statistical analysis in the "R" program, using the t test and ANOVA. Results: The results demonstrated that measures A' and Eis were underestimated in -0.15 ± 0. 52 mm and -0.47 ± 1.05 mm, respectively, while measures Pg' and ANL were overestimated at 0.76 ± 1.98 mm and 3.31 ± 3.60° respectively. There was no evidence of measures, Ls, Li and B', being different between real and virtual. Conclusions: The results of this study suggest that Dolphin 11.9® computer program complies with the function of preserving with reliability virtual surgical planning.

RESUMO Objetivo: O presente estudo teve como objetivo analisar a precisão do programa de computador Dolphin Imaging 11.9® na predição cirúrgica do perfil facial dos tecidos moles. Métodos: Os pesquisadores projetaram e implementaram um estudo retrospectivo. Utilizou-se uma amostra de 55 pacientes, sendo 14 do sexo masculino e 41 do sexo feminino, com idades entre 19 e 55 anos. Todos os pacientes foram submetidos à cirurgia ortognática bimaxilar combinada com mentoplastia, no perfil facial Classe II de Angle. Os resultados reais dos pacientes foram comparados com os obtidos até um ano e meio após o procedimento cirúrgico. O estudo foi delineado em três fases. Na primeira fase, foram realizadas radiografias cefalométricas pré-operatórias; na segunda fase, foram realizadas cefalometrias pós-operatórias; na terceira fase, as medidas do perfil mole da análise virtual foram comparadas com o perfil pós-cirúrgico real. Os dados foram coletados e submetidos à análise estatística no programa "R", utilizando o teste t e ANOVA. Resultados: Os resultados demonstraram que as medidas A 'e Eis foram subestimadas em -0,15 ± 0, 52 mm e -0,47 ± 1,05 mm, respectivamente; enquanto as medidas Pg' e ANL foram superestimadas em 0,76 ± 1,98 mm e 3,31 ± 3,60°, respectivamente. Não houve evidência de medidas, Ls, Li e B', sendo diferentes entre real e virtual. Conclusão: Os resultados deste estudo sugerem que o programa de computador Dolphin 11.9® cumpre a função de preservar com confiabilidade o planejamento cirúrgico virtual.

Anclaje esquelético para el tratamiento de las anomalías de clase II y mordida abierta anterior: informe de un caso / Skeletal anchorage for the treatment of class II anomalies and anterior open bite: report of a case

El reporte de este caso tiene como objetivo demostrar la utilidad de los anclajes esqueléticos temporarios como son las miniplacas cigomáticas y los microimplantes "buccal shelf" en el tratamiento ortodóncico, en una paciente de 17 años 10 meses de edad, clase II vertical, dólicofacial, con mordida abierta anterior y aumento de la altura facial inferior. Después de la primera fase de tratamiento, siguiendo la secuencia de arcos para completar la alineación, se utilizaron anclajes esqueléticos extrarradiculares con una mecánica de intrusión con fuerzas elásticas durante 10 meses. Se intruyeron sus piezas posteriores superiores e inferiores y se distalizó la arcada superior, corrigiéndose la oclusión. El mentón retrognático y su perfil convexo mejoraron con la autorrotación de la mandíbula (AU)

The objective of this report case is to demonstrate the usefulness of temporary skeletal anchors such as zygomatic miniplates and buccal shelf microimplants in orthodontic treatment, in a 17-year-old 10-month-old, vertical class II, dollicofacial patient with anterior open bite and increased lower facial height. After the first treatment phase, following the arch sequence to complete the alignment, extra-radicular skeletal anchors were used with intrusion mechanics with elastic forces for 10 months. Its upper and lower posterior pieces were intruded and the upper arch was distalized, correcting the occlusion. e retrognathic chin and its convex profile improved with autorotation of the jaw (AU)

Tratamento Ortocirúrgico de uma Maloclusão Classe II Esquelética: Relato de Caso / Orthosurgical Approach of a Skeletal Class II Malocclusion: Case Report

This article aims to present the clinical case of a young male patient who presented severe skeletal Class II malocclusion, who underwent orthosurgical treatment. This case reported the benefits that arise from treatment as well as evaluated changes in the upper airways. Data were collected through review of the medical records, study models, radiographs, cone beam tomography and intra and extra -oral photos. The proposed treatment provided desirable functional and aesthetic results, with adequate intercuspidation between dental arches, mandibular projection, resting. There was no increase in the volume and total area of the oropharynx as a result of orthognathic surgery, only an increase in the minimum axial area.

Este artigo tem objetivo de apresentar o caso clínico de um paciente jovem do gênero masculino que apresentava maloclusão Classe II esquelética severa e foi submetido a tratamento ortocirúrgico. O objetivo deste relato de caso foi abordar os benefícios decorrentes do tratamento bem como avaliar as mudanças das vias aéreas superiores. Os dados foram coletados por meio de revisão do prontuário, modelos de estudo, radiografias, tomografia cone beam e registros fotográficos intra e extrabucais. O tratamento proposto proporcionou resultados funcionais e estéticos desejáveis, com adequada intercuspidação entre os arcos dentários, projeção mandibular, selamento labial em repouso, harmonia facial. Não foi observado aumento do volume e área total da orofaringe em decorrência da cirurgia ortognática, apenas o aumento da área axial mínima.

Effects of the cervical headgear in growing Angle Class II malocclusion patients: a prospective study

ABSTRACT Objective: Evaluate dental and skeletal changes resulting from the exclusive use of the cervical headgear for 15 ± 4 months in the treatment of patients with Class II division 1 malocclusion. Methods: Differences between the beginning (T1) and immediately after the end of the therapy (T2) with the cervical headgear in growing patients (Experimental Group, EG, n = 23) were examined and compared, during compatible periods, with those presented by a group of untreated individuals (Control Group, CG, n =22) with similar malocclusions and chronological age. The cephalometric variables evaluated were: ANB, GoGn.SN, AO-BO, S'-ANS, S'-A, S'-B, S'-Pog and S'-U6 (maxillary first molar). The Shapiro-Wilk and Levene tests were used to evaluate the results. Results: Significant differences were found relative to the ANB, S'-U6, AO-BO, S'-ANS, S'-A, S'-B and S'-Pog variables between T1 and T2 when comparing both groups. No statistically significant variation was found regarding the GoGn.SN angle. Conclusions: The use of cervical headgear promoted distal movement of the maxillary first molars and restricted the anterior displacement of the maxilla, without significantly affecting the GoGn.SN angle.

RESUMO Objetivo: Avaliar as alterações dentárias e esqueléticas decorrentes do uso exclusivo do aparelho extrabucal durante 15 ± 4 meses para tratamento de pacientes com má oclusão de Classe II divisão 1 (Grupo Experimental, GE). Métodos: As diferenças entre o início (T1) e imediatamente após o término da terapia (T2) com o aparelho extrabucal de tração cervical (Grupo Experimental, GE, n = 23) foram comparadas àquelas apresentadas por um grupo composto por indivíduos não tratados (Grupo Controle, GC, n = 22), com má oclusão e faixa etária cronológica compatíveis. As variáveis cefalométricas avaliadas foram: ANB, GoGn.SN, AO-BO, S'-ENA, S'-A, S'-B, S'-Pog e S'-U6 (primeiro molar superior). Os testes de Shapiro-Wilk e Levene foram aplicados para avaliar os resultados. Resultados: Diferenças significativas entre T1 e T2 foram encontradas para as variáveis ANB, S'-U6, AO-BO, S'-ENA, S'-A, S'-B e S'-Pog, quando comparados os dois grupos. Nenhuma diferença estatisticamente significativa foi encontrada em relação ao ângulo GoGn.SN. Conclusão: O uso do aparelho extrabucal com tração cervical promoveu movimento para distal do primeiro molar superior e restringiu o deslocamento anterior da maxila, sem afetar significativamente o ângulo GoGn.SN.

Attractive perception of profile class II patients treated with extractions versus dentoalveolar mandibular advancement devices

Aim: This study aimed to compare the esthetic perception of profile silhouette of pictures of class II patients before and after treatment (extractions or mandibular advancement), according to a visual analog scale (VAS) among orthodontists, general dentists and lay people. Methods: A presentation of 18 class II adult patients silhouette was shown to three groups of participants (25 orthodontists, 25 general dentists, and 25 lay people) in two phases in an cross-sectional survey study. An initial presentation pre-treatment and a second one post-treatment, one month later. The presentation consisted of nine pictures of four extractions orthodontic cases (two maxillary premolars and two mandibular premolars): five males, four females, and other nine pictures with a dentoalveolar mandibular advance (Forsus® and/or class II elastics): four males, five females. To compare pre and post-treatment scores, an ANOVA test was performed. Independent variables studied were: sex, age, and previous or present orthodontic treatment of participants. Results:A total of 75 of evaluators scored 18 patient profiles before and after treatment. In the three groups, the post treatment silhouette scored significantly higher. Advancement treatment scored significantly higher than extractions, especially among lay people. Orthodontist gave the lowers score regardless of treatment. No differences were found between male and female scoring (p>0.05). The participants between 30-39 years old gave higher scores than other age groups(p<0,05). Conclusion: In our sample, class II orthodontic treatments did always improve esthetic perception of patients profile. Advancement treatment achieved a better esthetic perception than extractions, especially among lay people

Altering Vertical Dimension: A Literature Review / Alteración de la dimensión vertical: Revisión de la literatur a

The alteration of the vertical dimension it's been a controversial issue for more than 50 years, today is not known an exact protocol to determine what is the right vertical dimension for each person and the appropriate variation to which you can submit a patient without causing any type of joint, muscle, functional or aesthetic alteration. In this review, we show the different concepts and criteria that must be taken into account in order to carry out successful treatments, whether in dentate, partially edentulous or totally edentulous patients to determine a vertical dimension that adapts to each patient through parameters such as facial aesthetics, health of the temporomandibular joint, occlusion and phonetics.

La alteración de la dimensión vertical es un tema controvertido desde hace más de 50 años, al día de hoy no se conoce un protocolo exacto para determinar qué es la dimensión vertical adecuada para cada persona y la variación adecuada de esta a la que se puede alguna vez un paciente sin provocar algún tipo de alteración articular, muscular, funcional o estética. En este artículo de revisión de tema, se muestran los diferentes conceptos y criterios que se deben tener en cuenta para llevar a cabo el éxito los tratamientos que se realizan ya sea en pacientes dentados, editados o totalmente editados para determinar una dimensión vertical que se adaptan a cada paciente mediante parámetros como la estética facial, la salud de la articulación temporomandibular, oclusión y fonética.

Dental, skeletal and soft tissue effects of the Distal Jet appliance: A prospective clinical study

ABSTRACT Objective: This study evaluated the dental, skeletal and soft tissue effects in Class II malocclusion patients treated with Distal Jet appliance, compared to an untreated control group. Methods: 44 patients with Class II malocclusion were divided into two groups: Group 1 (experimental) - 22 patients, mean age of 12.7 years, treated with the Distal Jet appliance for a mean period of 1.2 years; Group 2 (control) - 22 untreated patients, mean age of 12.2 years, followed by a mean period of 1.2 years. Lateral cephalograms were obtained before treatment (T0) and at the end of the distalization (T1).Independent t test was used to identify intergroup differences. Results: When compared to control group, the Distal Jet produced a significant increase in mandibular plane angle (0.7 ± 2.0o). The maxillary second molars presented distal inclination (6.6 ± 3.8o), distalization (1.1 ± 1.1 mm) and extrusion (1.3 ± 2.1 mm). The maxillary first molars distalized by 1.2 ± 1.4 mm. The maxillary first premolars mesialized by 3.4 ± 1.1 mm. The maxillary incisors showed slight labial tipping of 4.3 ± 4.7o and were protruded by 2.4 ± 1.7 mm. There were no significant changes in the facial profile. The overjet increased 1.5 ± 1.1 mm and overbite had no significant changes. Conclusion: The Distal Jet appliance is effective to distalize the maxillary first molars, but promotes increase in mandibular plane angle, distal inclination, extrusion and distalization of maxillary second molars, mesialization of maxillary first premolars, proclination and protrusion of maxillary incisors, and increase in overjet, when compared to a control group.

RESUMO Objetivo: o presente estudo avaliou os efeitos dentoesqueléticos e tegumentares em pacientes com má oclusão de Classe II tratados com aparelho Distal Jet, comparando-os com um grupo controle não tratado. Métodos: 44 pacientes com má oclusão de Classe II foram divididos em dois grupos: Grupo 1 (experimental) - 22 pacientes, idade média de 12,7 anos, tratados com o aparelho Distal Jet por um período médio de 1,2 anos; Grupo 2 (controle) - 22 pacientes não tratados, idade média de 12,2 anos, acompanhados por um período médio de 1,2 anos. Telerradiografias laterais foram obtidas antes do tratamento (T0) e no final da distalização (T1). O teste t independente foi usado para identificar as diferenças entre os grupos. Resultados: quando comparado ao grupo controle, o Distal Jet produziu um aumento significativo no ângulo do plano mandibular (0,7 ± 2,0o). Os segundos molares superiores apresentaram inclinação distal (6,6 ± 3,8o), distalização (1,1 ± 1,1 mm) e extrusão (1,3 ± 2,1 mm). Os primeiros molares superiores foram distalizados por 1,2 ± 1,4 mm. Os primeiros pré-molares superiores, mesializados por 3,4 ± 1,1 mm. Os incisivos superiores mostraram leve inclinação labial de 4,3 ± 4,7o e foram protruídos por 2,4 ± 1,7 mm. Não existiram alterações significativas no perfil facial. O overjet aumentou 1,5 ± 1,1 mm, e o overbite não sofreu alterações significativas. Conclusão: o aparelho Distal Jet é eficaz para distalizar os primeiros molares superiores, mas promove aumento no ângulo do plano mandibular, inclinação distal, extrusão e distalização dos segundos molares superiores, mesialização dos primeiros pré-molares superiores, vestibularização e protrusão dos incisivos superiores e aumento do overjet, quando comparado a um grupo de controle.

Effects of Class II division 1 malocclusion treatment with three types of fixed functional appliances

ABSTRACT Objective: This study aimed at comparing the dentoskeletal changes in patients with Class II division 1 malocclusion, treated with three types of fixed functional appliances. Methods: A sample comprising 95 patients with the same malocclusion, retrospectively selected, and divided into four groups, was used: G1 consisted of 25 patients (mean age 12.77 ± 1.24 years) treated with Jasper Jumper appliance; G2, with 25 patients (mean age 12.58 ± 1.65 years) treated with the Herbst appliance; G3, with 23 patients (mean age 12.37 ± 1.72 years) treated with the Mandibular Protraction Appliance (MPA); and a Control Group (CG) comprised of 22 untreated subjects (mean age 12.66 ± 1.12 years). Intergroup comparison was performed with ANOVA, followed by Tukey test. Results: The Jasper Jumper and the Herbst group showed significantly greater maxillary anterior displacement restriction. The Jasper Jumper demonstrated significantly greater increase in the mandibular plane angle, as compared to the control group. The MPA group demonstrated significantly greater palatal inclination of the maxillary incisors. Vertical development of the maxillary molars was significantly greater in the Herbst group. Conclusions: Despite some intergroup differences in the amount of dentoskeletal changes, the appliances were effective in correcting the main features of Class II malocclusions.

RESUMO Objetivo: o objetivo do presente estudo foi comparar as alterações dentoesqueléticas em pacientes com má oclusão de Classe II, divisão 1, tratados com três tipos de aparelhos funcionais fixos. Métodos: a amostra compreendeu 95 pacientes, selecionados retrospectivamente e divididos em quatro grupos: G1, composto por 25 pacientes (idade média de 12,77 ± 1,24 anos), tratados com aparelho Jasper Jumper; G2, com 25 pacientes (idade média de 12,58 ± 1,65 anos), tratados com aparelho Herbst; G3, com 23 pacientes (idade média de 12,37 ± 1,72 anos), tratados com o Aparelho de Protração Mandibular (APM); e um Grupo Controle (GC), composto por 22 sujeitos não tratados (idade média de 12,66 ± 1,12 anos) que apresentavam a mesma má oclusão. A comparação intergrupos foi realizada com ANOVA, seguida do teste Tukey. Resultados: os grupos Jasper Jumper e Herbst apresentaram significativamente maior restrição de deslocamento anterior da maxila. O Jasper Jumper demonstrou aumento significativamente maior no ângulo do plano mandibular, em comparação ao grupo controle. O grupo APM demonstrou inclinação palatina significativamente maior dos incisivos superiores. O desenvolvimento vertical dos molares superiores foi significativamente maior no grupo Herbst. Conclusões: apesar de algumas diferenças intergrupos na quantidade de alterações dentoesqueléticas, os aparelhos foram eficazes na correção das principais características das más oclusões de Classe II.

Comparison of dentoskeletal and soft tissue effects of Class II malocclusion treatment with Jones Jig appliance and with maxillary first premolar extractions

Abstract Objective: The aim of this study was to compare the cephalometric changes in Class II division 1 malocclusion patients treated with Jones Jig appliance or with maxillary first premolar extractions. Methods: The sample consisted of 88 lateral cephalograms of 44 patients, divided into two groups. Group 1 consisted of 21 patients treated with Jones Jig appliance, with a mean initial age of 12.88 ± 1.23 years and final mean age of 17.18 ± 1.37 years, and a mean treatment time of 4.29 years. Group 2 comprised 23 patients treated with maxillary first premolar extractions, with a mean initial age of 13.59 ± 1.91 years and mean final age of 16.39 ± 1.97 years, and a mean treatment time of 2.8 years. Intergroup treatment changes were compared with t and Mann-Whitney tests. Results: Class II correction in G2 (maxillary first premolar extractions) presented significantly greater maxillary retrusion, reduction of anteroposterior apical base discrepancy, smaller increase in the lower anterior face height and significantly greater overjet reduction than G1 (Jones Jig). Conclusions: Treatment with maxillary first premolar extractions produced greater overjet reduction, but the two treatment protocols produced similar changes in the soft tissue profile.

Resumo Objetivo: o objetivo desse estudo foi comparar as alterações cefalométricas em pacientes com má oclusão de Classe II, divisão 1, tratados com o aparelho Jones Jig ou com extrações dos primeiros pré-molares superiores. Métodos: a amostra consistiu de 88 telerradiografias laterais de 44 pacientes, que foram divididos em dois grupos. O Grupo 1 consistiu de 21 pacientes tratados com o aparelho Jones Jig, com idade inicial média de 12,88 ± 1,23 anos e idade final média de 17,18 ± 1,37 anos, com tempo médio de tratamento de 4,29 anos. O Grupo 2 compreendeu 23 pacientes tratados com extrações dos primeiros pré-molares superiores, com idade inicial média de 13,59 ± 1,91 anos, idade final média de 16,39 ± 1,97 anos, e tempo médio de tratamento de 2,8 anos. A comparação intergrupos das alterações dos tratamentos foi realizada pelos testes t e de Mann-Whitney. Resultados: a correção da Classe II no G2 (extrações dos primeiros pré-molares superiores) apresentou uma retrusão maxilar significativamente maior, redução da discrepância anteroposterior das bases apicais, menor aumento da altura facial anteroinferior e uma redução significativamente maior do trespasse horizontal do que no G1 (aparelho Jones Jig). Conclusões: o tratamento com extrações dos primeiros pré-molares superiores promoveu maior redução do trespasse horizontal, mas os dois protocolos de tratamento produziram alterações semelhantes no perfil tegumentar.

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

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

Deglutition pattern in Angle's Class II malocclusion

ABSTRACT Purpose: to analyze the electromyographic activity of the suprahyoid muscles during deglutition in participants with Angle´s Class II malocclusion. Methods: electromyographic data recordings were performed in the supra-hyoid muscles during swallowing and at rest, in 30 volunteers, 15 Angle´s Class I participants and 15 Angle´s Class II malocclusion, aged 15-27 years old. The Root Means Square values for both tests were analyzed, and for the deglutition test, the Linear Envelope was used to observe the type of muscle activation pattern. Results: during the test at rest, there was no significant difference in Root Means Square values (p=0.22) between Class I and Class II subjects. During deglutition, it was found that Angle´s Class II subjects had significantly higher RMS values (p=0.01) as compared to Class I volunteers. Regarding the type of muscle activation pattern, there was a significant difference between Class I and Class II participants with a predominance of type 1 peak for Class I and type 2 peak for Class II. Conclusion: there was a difference in electromyographic recordings during deglutition in participants with Angle´s Class II as compared to Class I participants with a tendency towards two contraction peaks, showing a greater imbalance during the function. There was no difference between groups in the rest position.