Cephalometric deviations present in children and adolescents with temporomandibular joint disorders

INTRODUCTION: Temporomandibular disorders (TMD) have proved to be a risk factor for developing hyperdivergent facial growth patterns. OBJECTIVE: The aims of this study were: (1) Assess differences between the cephalometric measurements in children with articular TMD and a control group, before and after mandibular growth peak according to cervical vertebral maturation; and (2) Identify a predictive model capable of differentiating patients with TMD and control group patients based on early cephalometric characteristics. METHOD: The study included children and adolescents with maximum age of 17 years, divided into experimental group (n=30) diagnosed with articular TMD-according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for children and adolescents-subdivided according to growth stage, called pre-peak (n=17) and post-peak (n=13) and control group (n = 30), matched by gender, skeletal maturity stage of the cervical vertebrae and classification of malocclusion. Lateral cephalometric and craniofacial structures were traced and their relations divided into: Cranial base, maxilla, mandible, intermaxillary relations, vertical skeletal relations and dental relations. Differences between the means for each variable were evaluated by applying the statistical Student t test for independent samples. RESULTS: The means of the variables analyzed in the pre-peak showed no statistically significant differences. However, analysis of post-peak showed that the experimental group displayed decreased SNA and SNB and increased SN.Gn and 1.NB (p<0.05). CONCLUSION: It was possible to identify a predictive model able to differentiate patients with TMD and asymptomatic controls from early cephalometric characteristics.

Diagnóstico e planejamento do tratamento 3D: o futuro da cirurgia ortognática / Diagnosis and treatment planning in 3D: the future of orthognathic surgery

Desde o início da documentação de registros, ortodontistas e cirurgiões perceberam que a melhor maneira de representação da condição de um paciente seria em três dimensões (3D). A tomografia computadorizada de feixe cônico introduziu um novo conceito para o diagnóstico e planejamento clínico das deformidades dentofaciais e registro documental desses processos em 3D. Combinando a tomografia computadorizada com fotografias 3D e modelos 3D digitais, temos pela primeira vez, todas as informações diagnósticas reunidas em um único software com medidas livres de distorção ou ampliação. Nesse ambiente virtual, diferentes opções de tratamento podem ser simuladas e guias podem ser prototipadas para transportar o planejamento para a clínica com grande precisão. Contudo, como acontece com qualquer nova prática, a familiarização com seus princípios e técnicas é necessária para permitir a utilização eficaz e eficiente

Since the beginning of documental records, orthodontists and surgeons realized that the best way to represent the condition of a patient would be in three dimensional (3D). The cone beam computed tomography unfolded a new landscape for clinical diagnosis and treatment planning of dentofacial deformities and documental record of these processes in 3D. Combining CT with 3D photos and 3D digital models, we have for the first time, all the diagnostic information gathered in a single software with measures free of distortion or magnification. In this virtual environment, different treatment options can be simulated and guides can be prototyped to transport planning for the clinic with great precision. However, as with any new practice, familiarity with its principles and techniques is necessary to enable their efficient and effective use

Alterações cefalométricas presentes em crianças e adolescentes com desordens da ATM nas diferentes classificações sagitais de má oclusão / Cephalometric changes present in children and adolescents with TMJ disorders with different classes of malocclusions

INTRODUÇÃO: o acometimento da ATM por alterações degenerativas e deslocamentos do disco articular demonstrou ser um fator de risco para a identificação de indivíduos com padrões hiperdivergentes de crescimento facial. OBJETIVOS: avaliar diferenças entre as médias encontradas para as variáveis cefalométricas em crianças com DTM articular e grupo controle, nas diferentes classificações sagitais de má oclusão (Classe I, II e III de Angle). MÉTODO: foram incluídos crianças e adolescentes com idade máxima de 17 anos, divididos em grupo experimental (n = 30) com diagnóstico de DTM articular, segundo o eixo I do RDC/TMD para crianças e adolescentes, igualmente divididos em 3 sub-grupos (n= 10) de acordo com a classificação da má oclusão presente e grupo controle (n = 30) sem DTM, pareados por gênero, índice de maturidade esquelética vertebral cervical e classificação da má oclusão. Foram traçadas telerradiografias laterais e as estruturas craniofaciais e suas relações foram divididas em: base do crânio, maxila, mandíbula, relações intermaxilares, relações esqueléticas verticais e relações dentárias. As diferenças encontradas entre as médias, para cada uma das variáveis, foram avaliadas pela aplicação do teste estatístico t de Student para amostra independentes. RESULTADOS: o grupo experimental Classe I apresentou S.N.Ar (p = 0,05) aumentado, o grupo experimental Classe II apresentou S.N.Ar (p = 0,006) e NperpA (p = 0,037) diminuídos e S.Ar.Go (p = 0,045) aumentado e o grupo experimental Classe III apresentou N.A.P (p = 0,045), 1.NB (p = 0,001) e 1-NB (p = 0,017) aumentados e 1.1 (p = 0,004) diminuído, todos em relação aos seus respectivos controles CONCLUSÃO: as diferenças foram mais significantes nos pacientes com má oclusão de Classe II e de Classe III.

INTRODUCTION: the involvement of TMJ through degenerative changes and displacements of the articular disc proved to be an important risk factor when identifying individuals with vertical facial growth patterns. PURPOSES: to evaluate differences between cephalometric variables in children with articular TMD and a control group, checking the variations in relation to the different patterns of malocclusion (Class I, II and III). METHOD: the study included children and adolescents of up to a maximum age of 17, who were divided up into an experimental group (n=30) diagnosed with articular TMD, diagnosed in accordance with the RDC/TMD axis I for children and adolescents, and a control group (n=30) without TMD, further paired by gender, stage of cervical vertebral skeletal maturity and class of malocclusion. Lateral cephalogram was carried out and both the craniofacial structures and their relations were separated into: the cranial base, maxillary, mandible, intermaxillary relations, vertical skeletal relations and dental relations. The differences found between the means, for each of the variables, were evaluated through the application of the Student t statistical test for independent samples. RESULTS: the Class I experimental group presented increased S.N.Ar (p=0.05). The Class II experimental group presented reduced S.N.Ar (p=0.006) and NperpA (p=0.037) and increased S.Ar.Go (p=0.045). The Class III experimental group presented increased N.A.P (p=0.045), 1.NB (p=0.001) and 1-NB (p=0.017) and reduced 1.1 (p=0.004). CONCLUSION: differences were more significant in those patients who presented Class II and III malocclusions.