Tomographic evaluation of mandibular buccal shelf in patients with different vertical growth pattern / Evaluación de la placa ósea mandibular en pacientes con diferente patrón de crecimiento vertical

The purpose of this research was the tomographic evaluation of the Mandibular Buccal Shelf (MBS) in orthodontic patients with different vertical growth pattern. An observational, descriptive, cross-sectional and retrospective study was conducted. Tomographic images of patients aged 14 to 40 years were observed and a database was formed with those that met the inclusion criteria. The sample size was 10 for each group according to vertical growth pattern (hypodivergent, normodivergent and hyperdivergent). Then four zones of frequent insertion of extralveolar mini-screws were selected in the MBS, taking as a reference the mesial and distal roots of the first and second mandibular molar. When comparing the characteristics of MBS between vertical growth patterns, between sexes and hemiarchs, no statistically significant differences were found. However, when the characteristics of MBS were compared according to the reference root, it was found that there were statistically significant differences. The vestibular area to the distal root of the second mandibular molar presented the highest values in terms of angulation, height and thickness. There are no significant differences in the bone characteristics of MBS according to vertical growth patterns, sexes or hemiarchs. Angulation, height and thickness progressively increase from the vestibular bone of the mesial root of the first mandibular molar to the distal root of the second molar.

El propósito de esta investigación fue la evaluación tomográfica de la placa ósea mandibular (POM) en pacientes de ortodoncia con diferente patrón de crecimiento vertical. Se realizó un estudio de tipo observacional, descriptivo, transversal y retrospectivo. Se observó imágenes tomográficas de pacientes de 14 a 40 años de edad y se formó una base de datos con las que cumplían los criterios de selección. El tamaño de muestra fue de 10 para cada grupo según patrón de crecimiento vertical (hipodivergentes, normodivergentes e hiperdivergentes). Luego se seleccionaron cuatro zonas de inserción frecuente de minitornillos extralveolares en la POM, tomando como referencia las raíces mesial y distal del primer y segundo molar mandibular. Al realizar la comparación de las características de la POM entre patrones de crecimiento vertical, entre sexos y hemiarcadas no se encontraron diferencias estadísticamente significativas. Sin embargo, cuando se comparó las características de la POM según la raíz de referencia se encontró que había diferencias estadísticamente significativas. La zona vestibular a la raíz distal de la segunda molar mandibular presento los mayores valores en cuanto angulación, altura y grosor. No existen diferencias significativas en las características óseas de la POM según patrones de crecimiento vertical, sexos o hemiarcadas. La angulación, la altura y el grosor aumenta progresivamente desde el hueso vestibular de la raíz mesial del primer molar mandibular hacia la raíz distal del segundo molar.

Craniofacial morphology of patients with unilateral cleft lip and palate at two stages of skeletal maturation

Abstract The aim of this retrospective cross-sectional investigation was to perform a 3D analysis of craniofacial morphology of patients with unilateral cleft lip and palate (UCLP) at two stages of skeletal maturation. Cone-beam computed tomography (CBCT) scans of 52 UCLP patients (34 prepubertal; 18 pubertal) were collected from an outpatient referral center for the treatment of craniofacial deformities. In total 15 multiplanar craniofacial landmarks were identified, 3D virtual surface models were created, and 13 variables were measured to assess the 3D Euclidean distances between landmarks and spatial position of the landmarks in the projected X, Y and Z components. Maxillary and mandibular pitch (clockwise, counterclockwise) rotation relative to the cranial base was also evaluated. The significance level was set at 5%. Maxillary retrusion value relative to the cranial base was higher and statistically significant greater (p = 0.028) in pubertal (SNA, 77.4° ± 6.2; N-ANS Y, 3.3 mm ± 3.1) than in prepubertal patients (SNA 81.0° ± 5.2; N-ANS Y, 5.8 mm ± 2.7). The posterior cranial base length (S-Ba Y) was significantly longer (p = 0.013) in pubertal (20.7 mm ± 3.4) than in prepubertal patients (18.4 mm ± 2.7). The upper facial height (N-ANS Z) was significantly greater (p = 0.01) in pubertal (46.9 mm ± 4.5) than in prepubertal patients (43.4 mm ± 3.0). Prepubertal and pubertal UCLP patients presented distinct patterns of craniofacial morphology, mainly in the sagittal component of the maxilla and in the posterior cranial base length. Pubertal patients had greater maxillary retrusion and posterior cranial base length.

Oral and cephalometric characteristics of hypohidrotic ectodermal dysplasia: Case report / Características orales y cefalométricas de la displasia ectodérmica hipohidrótica: Reporte de caso

ABSTRACT Hypohydrotic ectodermal dysplasia (HED) is a genetic disorder that affects the development of ectodermal tissues. This study reports a case of a 5-year-old male patient, with clinical extra and intraoral characteristics of HED. The intraoral clinical examination revealed a generalized absence of teeth, panoramic radiograph revealed the presence of permanent first molars with taurodontism, and confirm the oligodontia. Cephalometric analysis revealed a class III skeletal relationship, due to deficiency in the sagittal development of the maxilla and an anti-clockwise growth tendency. Alterations in craniofacial development require multidisciplinary treatment and long-term follow-up to monitor craniofacial growth.

RESUMEN La displasia ectodérmica hipohidrótica (DEH) es un trastorno genético que afecta el desarrollo de los tejidos ectodérmicos. Se realiza el reporte de caso de un paciente masculino de 5 años, con características clínicas extra e intraorales de DEH. El examen clínico intraoral reveló una ausencia generalizada de dientes, la radiografía panorámica reveló la presencia de primeros molares permanentes con taurodontismo y confirmó la oligodoncia. El análisis cefalométrico reveló una relación esquelética de clase III, debido a la deficiencia en el desarrollo sagital del maxilar y una tendencia de crecimiento en sentido antihorario. Las alteraciones en el desarrollo craneofacial requieren un tratamiento multidisciplinario y un seguimiento a largo plazo para controlar el crecimiento craneofacial.

Morfología cefalométrica de la sínfisis del mentón en individuos jóvenes de la ciudad de Quito-Ecuador / Cephalometric morphology of chin symphysis in young individuals from the city of Quito-Ecuador

Resumen Introducción: La sínfisis del mentón aporta equilibrio, simetría y armonía al rostro. Por ser una estructura anatómica mandibular muy importante y altamente modificable en cirugía estética, se considera indispensable conocer su morfología y así obtener una correcta interacción en el diagnóstico, pronóstico y terapéutica médico-odontológica. Objetivo: Determinar la morfología sínfisis del mentón en jóvenes adultos de la ciudad de Quito- Ecuador, año 2019, mediante la identificación de las longitudes sagitales y coronales. Metodología: Este estudio tuvo un enfoque cuantitativo, tipo descriptivo-observacional, con temporalidad retrospectiva. Se calibraron, analizaron y trazaron 384 radiografías digitales laterales de adultos jóvenes de la ciudad de Quito-Ecuador, año 2019 en el software AutoCAD-2019. Resultados: Existió una elevada frecuencia de la forma geométrica cuadrada (60%) con respecto a la rectangular (40%), adicionalmente se identificó que la figura cuadrada es más frecuente en individuos de sexo femenino y sujetos clase I (56%) y II (70%), además de todos los patrones de crecimiento vertical hipodivergentes (58%), normodivergentes (64%) e hiperdivergentes (57%). Conclusiones: La forma cuadrada de la sínfisis del mentón es mayor que la forma rectangular. Por la originalidad de los resultados, se sugiere realizar nuevos estudios que correlacionen la morfología mentoniana con las diferentes estructuras cráneo-maxilofaciales.

Abstract Introduction: The chin symphysis contributes to the balance, symmetry and harmony of the face. Since it is an important anatomical jaw structure and highly modifiable in aesthetic surgery, it is considered crucial to know its morphology and, thus, obtain a correct interaction in the diagnosis, prognosis and medical-dental therapy. Objective: To determine the symphysis morphology of the chin in young adults in the city of Quito, Ecuador, in the year 2019, through the identification of sagittal and coronal lengths. Methodology: This study had a quantitative approach, descriptive-observational type, with retrospective temporality. We calibrated, analyzed and plotted 384 lateral digital radiographs of young adults from the city of Quito-Ecuador, year 2019 in the software AutoCAD-2019. Results: There was a high frequency of the square geometric shape (60%) in comparison to the rectangular one (40%). Additionally, it was identified that the square figure is more frequent in female individuals and class I (56%) and II (70%) subjects, in addition to all the hypodivergent (58%), normodivergent (64%) and hyperdivergent (57%) vertical growth patterns. Conclusions: The square shape of the chin symphysis is larger than the rectangular shape. Due to the originality of the results, it is suggested to carry out new studies that correlate chin morphology with the different cranio-maxillofacial structures.

China experts' consensus on preventive and interceptive orthodontic treatments of malocclusions of children / 华西口腔医学杂志

Malocclusion is one of the three most common oral diseases reported by World Health Organization(WHO). In China, its incidence rate is rising. Malocclusion seriously affects the dental and maxillofacial function, facial appearance and growth development of nearly 260 million children in China, and what is more, it affects their physical and mental health development. Malocclusion occurrence is related to genetic and environmental factors. Early treatment of malocclusion can create a good dental and maxillofacial development environment, correct abnormal growth and control the adverse effects of abnormal genetic factors. It can effectively reduce the prevalence of children's malocclusion and enhance their physical and mental health. This is an urgent need from the economic perspective of our society, so it has great practical and social significance. Experts from the project group "standard diagnose and treatment protocols for early orthodontic intervention of malocclusions of children" which initiated by China National Health Institute of Hospital Administration wrote the "China Experts' Consensus on Preventive and Interceptive Orthodontic Treatments of Malocclusions of Children", which aims to guide and popularize the clinical practice, improve the clinical theory and practice level, and accelerate the disciplinary development of early treatment of children's malocclusion in China. The consensus elaborates the harmfulness of malocclusion and the necessity of early treatment, and brings up the principles and fundamental contents. Based on the law of dental and maxillofacial development, this paper puts forward the guiding suggestions of preventive and interceptive treatments in different stages of dental development ranging from fetus to early permanent dentition. It is a systematic project to promote and standardize the early treatment of malocclusion. Through scientific and comprehensive stratified clinical practice and professional training, the clinical system of early treatment of malocclusion in China will eventually be perfected, so as to comprehensively care for children's dental and maxillofacial health, and improve their oral and physical health in China.

Tratamiento de mordida cruzada anterior con aparato de tracción extraoral Máscara Delaire en paciente con estrabismo: Reporte de caso / Anterior crossbite treatment with headgear: Delaire mask in a patient with strabismus: Case reportCitaciónAriza JA, Flórez AP, Hurtado ME. Tratamiento de mordida cruzada anterior con aparato de tracción extraoral Máscara Delaire en paciente con estrabismo: Reportede caso

In Class III malocclusion with anterior crossbite exist an altered relationship between maxilla and mandible: maxillary retrognathism, mandibular prognathism or a combination of these; this disharmony can alter facial aesthetics. The etiology is multifactorial; hereditary and environmental (habits, enlarged tonsils and mandibular posture). Considering the etiological factor is crucial to establish an adequate treatment plan and achieve long-term stability.An intervention at an early age can achieve a normal function and harmony in the relationship of the jaws, thus improving the aesthetics of the patient. There are several treatment options depending on age such as maxillary orthopedics, orthodontics and orthognathic surgery. This case report depictsa 9-year-old and 7-month-old female patient, with strabismus,whose mother consults because "her jaw is getting out";the clinical and cephalometric findings determine a class III malocclusion with maxillary retrognathism, anterior cross bite, vertical growth, mixed breathing with nasal predominance, atypical swallowingand sigmatism. The treatment was developed in 2 phases: first mechanical orthopedics with Hyrax and Delaire's facial mask for 11 months, in the second phase SN3 functional orthopedic appliance (small lower fins). The changes obtained with Delaire's facial mask are evidenced at the facial, dental and skeletal level, without compromising the strabismus alteration that the patient presents and handles with glasses.

En la maloclusión clase III con mordida cruzada anterior existe una alteración en la relación máxilo-mandibular: retrognatismo maxilar, prognatismo mandibular o combinada, esta desarmonía puede alterar la estética facial. Si se interviene a una edad temprana se puede lograr la normalidad de la funciones y armonía en la relación de los maxilares, llevando a mejorar la estética del paciente. Es importante tener en cuenta el factor etiológico para establecer un adecuado plan de tratamiento y lograr estabilidada largo plazo. La etiología es multifactorial; hereditaria y ambiental (hábitos, agrandamiento de las amígdalas y postura mandibular). Existen varias opciones de tratamiento dependiendo de la edad como ortopedia maxilar, ortodoncia y cirugía ortognática.Este reporte de caso,presenta una paciente de 9 años y 7 meses de edad, género femenino, con estrabismo, cuya madre consulta porque "se le está saliendo la mandíbula"; los hallazgos clínicos y cefalométricos determinan una maloclusión clase III con retrognatismo maxilar, mordida cruzada anterior, crecimiento vertical, respiración mixta con predominio nasal, deglución atípica y sigmatismo. El tratamiento que se realizó en este paciente fue en 2 fases: en la primera ortopedia mecánica con Hyrax y máscara facial de Delaire por 11meses y en la segunda fase aparato de ortopedia funcional SN3 (pequeñas aletas inferiores). Los cambios obtenidos con máscara facial de Delaire se evidencian a nivel facial, dental y esquelético, sin comprometer la alteración de estrabismo que la pacientepresenta y maneja con gafas.

Cephalometric assessment of Colombia's mestizo population aged 6 to 12 years / Evaluación cefalométrica de la población mestiza colombiana entre 6 a 12 años

ABSTRACT Introduction: over the years, populations have been studied by means of lateral cephalic x-rays in a variety of ethnicities, ages, and study types, setting standards for different groups. In Latin America, studies show cephalometric differences from standards based on Caucasian populations. Method: 1,627 cases of patients without prior treatment were analyzed; the sample included 855 males and 772 females aged 6 to 12 years. Lateral cephalic radiographs and specific tracing were taken. Descriptive analysis was done using mean, standard deviation, minimum, and maximum. Comparisons were made between male and female subjects and by age. Results: a greater size was found in all measurements in male subjects, being statistically significant in some measurements and ages. The ages with the most differences were 8 and 9 years, and the least difference occurred at the age of 10. Conclusion: there was variation in maxillary and mandibular size with age and gender, with the largest size in males and indications of vertical predominance.

RESUMEN Introducción: a través de los años se han estudiado poblaciones por medio de radiografías cefálicas laterales, en variedad de etnias, edades y tipos de estudio, lo que ha permitido establecer estándares para diferentes grupos. En Latinoamérica, los estudios demuestran diferencias cefalométricas respecto a las normas basadas en poblaciones caucásicas. Método: se analizaron 1.627 casos de pacientes sin tratamiento previo, 855 hombres y 772 mujeres entre 6 y 12 años. Se tomó radiografía cefálica lateral y un trazado específico. Se realizó análisis descriptivo utilizando media, desviación estándar, mínimo y máximo. Se hizo comparación entre los sujetos masculinos y femeninos y por edades. Resultados: se encontró mayor tamaño en todas las medidas en hombres, siendo estadísticamente significativas en algunas medidas y edades. La edad que mayor diferencia presenta es a los 8 y 9 años, y la de menor diferencia es a los 10 años. Conclusión: se presentó variación en el tamaño maxilar y mandibular con la edad y el género, con mayor tamaño en los hombres y con características de manifestaciones de predominio vertical.

Alterações dentoesqueléticas associadas aos aparelhos Twin Block e Herbst com e sem ancoragem esquelética no tratamento da má oclusão Classe II: um ensaio clínico randomizado / Dentoskeletal changes associated to Twin Block and Herbst appliances with and without skeletal anchorage in the Class II malocclusion treatment: a randomized clinical trial

O objetivo deste ensaio clínico randomizado foi comparar os efeitos dentoesqueléticos associados ao tratamento da má oclusão de Classe II de Angle 1a divisão com propulsores mandibulares removíveis, fixos e associados à ancoragem esquelética. Após o exame de 1039 indivíduos, foram incluídos 34 pacientes Classe II de Angle, 1a divisão com overjet ≥ 6 mm, de 10 a 14 anos, no pico do surto de crescimento puberal e sem tratamento ortodôntico prévio. Estes pacientes foram distribuídos de forma randomizada em três grupos: (TB) tratado com aparelho removível de Twin Block (n = 13); (HAD) tratado com aparelho fixo cimentado de Herbst (n = 11); e (HAE) tratado com aparelho de Herbst associado a dois mini-implantes mandibulares (n = 10). Foram analisadas tomografias de feixe cônico antes da instalação do propulsor (T1) e após 12 meses de tratamento (T2). No programa ITK-SNAP®, foram construídos modelos 3D da maxila, mandíbula, incisivos centrais e 1os molares. No programa Dolphin Imaging®, foram gerados modelos 3D totais do tecido duro de T1 e T2, com orientação de cabeça padronizada e registro na base craniana anterior. O Modelo de Transferência de Coordenadas (MTC) foi obtido a partir do recorte padronizado do tecido mole de T1, nos planos axial, sagital e coronal. No programa Geomagic Qualify®, os modelos 3D parciais foram alinhados à posição espacial dos modelos 3D totais orientados e registrados. Foi utilizado um método automático para determinar os pontos centroides, que representaram a posição espacial de todas as estruturas anatômicas avaliadas. Os deslocamentos dos centroides entre T1 e T2 foram analisados no sistema de coordenados cartesiano elaborado com base no MTC. Para análise do crescimento maxilar e do mento foi utilizado o registro craniano; para a movimentação dentária e crescimento condilar, foram adotados os registros regionais em maxila e mandíbula. O teste de Wilcoxon avaliou as diferenças intra-grupo e o teste de Kruskal Wallis analisou as diferenças intergrupos das alterações esqueléticas e dentárias. Foram comparados os índices de sucesso na correção da sobressaliência e relação molar. Foi detectada restrição de crescimento anteroposterior da maxila (HAE: -0,26 ± 2,88 mm; TB -0,25 ± 0,66 mm; HAD: 0,18 ± 0,87 mm) e crescimento mandibular anteroposterior (HAE: 4,21 ± 2,96 mm; HAD: 3,49 ± 3,74 mm; TB: 1,24 ± 3,36 mm). No arco superior, foi observada mínima movimentação de incisivos e 1os molares (≤ 1 mm nos 3 planos). Os principais efeitos dentários ocorreram no arco inferior, na perda de ancoragem (HAD: 1,73 ± 0,64 mm; TB: 1,45 ± 1,13 mm; HAE: 1,07 ± 0,23 mm) e mínima projeção dos incisivos centrais (HAE: 0,93 ± 0,08 mm; HAD: 0,54 ± 0,36 mm; TB: 0,27 ± 0,18 mm). Quanto à eficácia, a maior correção do overjet foi obtida pelos grupos HAD (-4 ± 1,65 mm) e HAE (-4 ± 1,47 mm), seguidos pelo TB (-3 ± 3,25 mm). Na relação molar, a maior eficácia foi do grupo HAE (100% de sucesso, sobrecorreção de 85,7%), seguido pelo HAD (100% de sucesso, sobrecorreção de 70%), e TB (55,6% de sucesso). Concluiu-se que o aparelho de Herbst associado aos mini-implantes obteve maior eficácia na correção predominantemente esquelética da má oclusão de Classe II 1a divisão, do que os aparelhos de Herbst e Twin Block, após 12 meses de tratamento(AU)

The aim of this randomized controlled trial was to compare the dentoskeletal effects associated to the treatment of Angle Class II 1st division with removable, fixed and skeletal anchored functional appliances. After the clinical examination of 1039 individuals, 34 patients with Angle Class II, 1st Division, overjet ≥ 6 mm, 10 to 14 years old, at the peak of the pubertal growth spurt and no history of orthodontic treatment were included. These patients were randomized into three groups: (TB) treated with removable Twin Block appliance (n = 13); (HAD) treated with fixed cemented Herbst appliance (n = 11); and (HAE) treated with Herbst appliance associated to two mandibular mini implants (n = 10). Cone-beam CT scans were obtained before (T1) and after 12 months of treatment (T2). In the ITK-SNAP® software, 3D models of the maxilla, mandible, central incisors and 1st molars were built. In the Dolphin Imaging® software, full 3D models of T1 and T2 hard tissue were generated, with standardized head orientation and registration in the anterior cranial base. The Coordinate Transfer Model (CTM) was obtained from the T1 soft tissue, with standardized slices in the axial, sagittal and coronal planes. In the Geomagic Qualify® software, the partial 3D models were aligned to the spatial position of the oriented and registered full 3D models. An automatic method was used to determine centroid points, which represented the spatial position of all evaluated anatomical structures. Centroid displacements between T1 and T2 were analyzed using the Cartesian coordinate system based on the CTM. The cranial register was used to analyze the growth of maxilla and chin; to measure tooth movement and condylar growth, the regional register in the maxilla and mandible were adopted. The Wilcoxon test assessed intra-group differences and the Kruskal Wallis test analyzed intergroup differences in skeletal and dental changes. Success rates for overjet correction and molar relationship were compared. Anteroposterior maxillary growth restriction was detected (HAE: -0.26 ± 2.88 mm; TB -0.25 ± 0.66 mm; HAD: 0.18 ± 0.87 mm) and also anteroposterior mandibular growth (HAE: 4.21 ± 2.96 mm; HAD: 3.49 ± 3.74 mm; TB: 1.24 ± 3.36 mm). In the upper arch, minimal movement of incisors and 1st molars was observed (≤ 1 mm in the 3 planes). The main dental effects occurred in the lower arch, in the anchorage loss (HAD: 1.73 ± 0.64 mm; TB: 1.45 ± 1.13 mm; HAE: 1.07 ± 0.23 mm) and minimal projection of central incisors (HAE: 0.93 ± 0.08 mm; HAD: 0.54 ± 0.36 mm; TB: 0.27 ± 0.18 mm). The highest overjet correction was obtained by the HAD (-4 ± 1.65 mm) and HAE (-4 ± 1.47 mm) groups, followed by TB (-3 ± 3.25 mm). In the molar relationship, the highest efficacy was in the HAE group (100% successful, 85.7% overcorrected), followed by HAD (100% successful, 70% overcorrected), and TB (55.6% successful). It was concluded that the Herbst appliance associated with mini-implants had greater efficacy in predominantly skeletal correction of Class II 1st division malocclusion than the Herbst and Twin Block appliances after 12 months of treatment(AU)

Premaxilla: up to which age it remains separated from the maxilla by a suture, how often it occurs in children and adults, and possible clinical and therapeutic implications: Study of 1,138 human skulls

ABSTRACT Objective: To evaluate topographic and temporal aspects of premaxillary bone and premaxillary-maxillary suture, since they are fundamental anatomical elements little explored clinically. Methods: 1,138 human dry skulls were evaluated, of which 116 (10.19%) of the specimens were children, and 1,022 (89.81%) were adults. The skulls were photographed and the percentage of premaxillary-maxillary suture opening was determined. Subsequently the data were tabulated and submitted to statistical analysis, adopting a level of significance of 5%. Results: The progression of premaxillary suture closure from birth to 12 years of age was 3.72% per year. In 100% of the skulls up to 12 years, the premaxillary-maxillary suture open in the palatal region was observed, while 6.16% of adults presented different degrees of opening. Conclusions: The premaxilla exists in an independent way within the maxillary complex and the presence of the premaxilla-maxillary suture justifies the success of anteroposterior expansions to stimulate the growth of the middle third of the face, solving anatomical and functional problems.

RESUMO Objetivo: avaliar aspectos topográficos e temporais do osso pré-maxilar e da sutura pré-maxilar/maxilar, por serem elementos anatômicos fundamentais pouco explorados clinicamente. Métodos: foram avaliados 1.138 crânios secos humanos, sendo 116 (10,19%) dos espécimes crianças e 1.022 (89,81%) adultos. Os crânios foram fotografados e determinou-se a porcentagem de abertura da sutura pré-maxilar/maxilar. Posteriormente, os dados foram tabulados e submetidos a análise estatística, adotando-se nível de significância de 5%. Resultados: a progressão de fechamento da sutura pré-maxilar/maxilar do nascimento aos 12 anos de idade foi de 3,72% ao ano. Em 100% dos crânios até 12 anos, observou-se a sutura pré-maxilar/maxilar aberta na região palatina, enquanto 6,16% dos adultos apresentavam diferentes graus. Conclusões: a pré-maxila existe de forma independente dentro do complexo maxilar e a presença da sutura pré-maxilar / maxilar justifica o sucesso de expansões anteroposteriores para estimular o crescimento do terço médio da face, solucionando problemas anatômicos e funcionais.

Orthognathic treatment of facial asymmetry due to temporomandibular joint ankylosis

The aim of this study was to present a case series of the orthognathic treatment of facial asymmetry due to temporomandibular joint (TMJ) ankylosis and to characterize the current treatment modalities through a literature review. Four patients who presented with facial asymmetry due to TMJ ankylosis between 2010 and 2014 were included in this study. TMJ ankylosis was surgically treated before bimaxillary surgery with advancement genioplasty in some of the cases. In 2 cases, 3-dimensional (3D) models were used for diagnosis and treatment planning, as 3D models are very important tools for planning surgical maneuvers. Aesthetically pleasant facial symmetry and a good facial profile were obtained in all the cases.

Clinical evaluation for chin augmentation: literature review and algorithm proposal / Avaliação clínica para avanço de mento: revisão da literatura e proposta de um algoritmo

ABSTRACT INTRODUCTION: The esthetic balance of the face results from harmonic and symmetrical facial proportions. The literature describes several methods for lower-third facial analysis, but lacks a simple and practical method. OBJECTIVE: To review the methods of analysis of the ideal projections of the chin based on soft tissues, showing the advantages and disadvantages of each. METHODS: Literature review through the PubMed database. RESULTS: The following methods for chin analysis based on soft tissues were reviewed: Gonzalles-Ulloa, Goode, Merrifield, Silver, Legan, Gibson & Calhoun, cervicomentual angle, and mentocervical angle. CONCLUSION: An adequate analysis of the proportions of the face and facial disharmony is essential for the correct indication of the necessary procedures and good surgical outcome. The authors propose an algorithm to facilitate the indication for chin augmentation surgery.

Resumo Introdução: O equilíbrio estético da face resulta de proporções faciais harmônicas e simétricas. A literatura descreve vários métodos de análise do terço inferior da face, mas carece de um método simples e prático. Objetivo: Revisar os métodos de análise da projeção ideal do mento baseadas em tecidos moles, mostrando as vantagens e desvantagens de cada um. Método: Revisão da literatura através da base de dados Pubmed. Resultados: Os seguintes métodos para análise do mento baseada em partes moles são revisados: Gonzalles-Ulloa, Goode, Merrifield, Silver, Legan, Gibson & Calhoun, ângulo cervicomentual e ângulo mentocervical. Conclusão: A análise adequada das proporções da face e desarmonia facial faz-se essencial para a correta indicação dos procedimentos necessários e bom resultado cirúrgico. Propomos um algoritmo para facilitar indicação de avanço de mento.

Improving gingival smile by means of guided bone regeneration principles

ABSTRACT Objective: This study evaluated the effectiveness of guided bone regeneration (GBR) carried out with xenogenic bone substitute (Bio-OssTM) and collagen resorbable membrane (Bio-GideTM) to improve gingival smile (GS) in patients with excessive vertical maxillary growth (EVMG). Methods: Twelve healthy women aged between 20 and 49 years old (mean age of 26 years), with 5 mm or more of gingival exposure during fully posed smile (FPS) due to EVMG, were included. Baseline digital photographs were taken with standardized head position at rest and FPS. In eight out of 12 cases, crown lengthening procedure was indicated and the initial incision was made 2 to 4 mm from the gingival margin. In four cases, with no indication for crown lengthening procedure, a sulcular incision was performed. GBR was performed in all cases, using micro screws and/or titanium mesh associated with Bio-OssTM and Bio-GideTM. After 10 days, sutures were removed. Recall appointments were scheduled at 1, 6, and 12 months when standardized photographs were again taken. ImageToolTM software was used to measure the gingival exposure (GE) during FPS from the standardized close-up smile photographs at baseline and 12 months. Results: GE mean at baseline was 275.44 mm2. After 12 months, patients who undergone exclusively GBR procedure, presented GE reduction of 40.7%, ∆ = 112.01 mm2 (statistically significant, p = 0.12), and patients who had crown lengthening associated with the graft had a reduction of 60%, ∆ = 167.01 mm2. Conclusion: Our results using GBR to improve GS in cases of EVMG showed an exceptionally high patient acceptance and satisfaction. One-year follow-up confirmed stable results.

RESUMO Objetivo: o presente estudo avaliou a eficácia da regeneração óssea guiada (ROG) usando enxerto ósseo xenógeno (Bio-Oss(r)) e membrana de colágeno reabsorvível (Bio-Gide(r)) para melhorar a estética do "sorriso gengival" (SG) em pacientes com crescimento maxilar vertical excessivo (CMVE). Métodos: foram incluídas 12 mulheres saudáveis com idades entre 20 e 49 anos (média = 26 anos) com 5mm ou mais de exposição gengival durante o sorriso amplo posado (SAP), em função de CMVE. Foram realizadas fotografias digitais padronizadas (FDP) em repouso e em SAP. Em 8 dos 12 casos, foi indicado o procedimento de aumento da coroa clínica, e a incisão inicial foi realizada de 2 a 4mm da margem gengival. Em 4 casos, para os quais não houve indicação de aumento da coroa clínica, foi realizada uma incisão intrassulcular. A ROG foi realizada, em todos os casos, utilizando-se mini-implantes e/ou malha de titânio, associados a Bio-Oss(r) e Bio-Gide(r). Após 10 dias, as suturas foram removidas. O programa ImageTool(r) foi utilizado para medir a "área gengival exposta" (AGE) durante o SAP, nas imagens padronizadas do sorriso, em close-up, ao início do estudo e após 12 meses. Resultados: a média da AGE no início do estudo foi de 275,44mm2. Após 12 meses, os pacientes submetidos exclusivamente ao procedimento de ROG apresentaram redução na AGE de 40,7%, Δ = 112,01mm2 (estatisticamente significativo, p = 0,12); já nos pacientes em que o aumento de coroa clínica foi associado ao enxerto, a redução foi de 60%, Δ = 167,01mm2. Conclusão: os resultados do uso da ROG para melhorar o SG em casos de CMVE demonstraram aceitação e satisfação extremamente elevadas por parte dos pacientes. O acompanhamento de 1 ano pós-tratamento confirmou a estabilidade dos resultados.

Morfología cefalométrica de la sínfisis del mentón en individuos jóvenes de la ciudad de Quito-Ecuador

Introducción: La sínfisis del mentón aporta equilibrio, simetría y armonía al rostro. Por ser una estructura anatómica mandibular muy importante y altamente modificable en cirugía estética, se considera indispensable conocer su morfología y así obtener una correcta interacción en el diagnóstico, pronóstico y terapéutica médico-odontológica. Objetivo: Determinar la morfología sínfisis del mentón en jóvenes adultos de la ciudad de Quito- Ecuador, año 2019, mediante la identificación de las longitudes sagitales y coronales. Metodología: Este estudio tuvo un enfoque cuantitativo, tipo descriptivo-observacional, con temporalidad retrospectiva. Se calibraron, analizaron y trazaron 384 radiografías digitales laterales de adultos jóvenes de la ciudad de Quito-Ecuador, año 2019 en el software AutoCAD-2019. Resultados: Existió una elevada frecuencia de la forma geométrica cuadrada (60%) con respecto a la rectangular (40%), adicionalmente se identificó que la figura cuadrada es más frecuente en individuos de sexo femenino y sujetos clase I (56%) y II (70%), además de todos los patrones de crecimiento vertical hipodivergentes (58%), normodivergentes (64%) e hiperdivergentes (57%). Conclusiones: La forma cuadrada de la sínfisis del mentón es mayor que la forma rectangular. Por la originalidad de los resultados, se sugiere realizar nuevos estudios que correlacionen la morfología mentoniana con las diferentes estructuras cráneo-maxilofaciales.

Introduction: The chin symphysis contributes to the balance, symmetry and harmony of the face. Since it is an important anatomical jaw structure and highly modifiable in aesthetic surgery, it is considered crucial to know its morphology and, thus, obtain a correct interaction in the diagnosis, prognosis and medical-dental therapy. Objective: To determine the symphysis morphology of the chin in young adults in the city of Quito, Ecuador, in the year 2019, through the identification of sagittal and coronal lengths. Methodology: This study had a quantitative approach, descriptive-observational type, with retrospective temporality. We calibrated, analyzed and plotted 384 lateral digital radiographs of young adults from the city of Quito-Ecuador, year 2019 in the software AutoCAD-2019. Results: There was a high frequency of the square geometric shape (60%) in comparison to the rectangular one (40%). Additionally, it was identified that the square figure is more frequent in female individuals and class I (56%) and II (70%) subjects, in addition to all the hypodivergent (58%), normodivergent (64%) and hyperdivergent (57%) vertical growth patterns. Conclusions: The square shape of the chin symphysis is larger than the rectangular shape. Due to the originality of the results, it is suggested to carry out new studies that correlate chin morphology with the different cranio-maxillofacial structures.

Ocorrência de disfunção temporomandibular em indivíduos com deformidade dentofacial / The occurrence of temporomandibular disorders in subjects presented with dentofacial deformities

Resumo:OBJETIVO:verificar a ocorrência de disfunção temporomandibular em indivíduos com deformidade dentofacial.MÉTODOS:foram avaliados 60 indivíduos de ambos os gêneros e idade entre 18 e 40 anos (média=27 anos), sendo formados dois grupos, um composto por 30 sujeitos com deformidade dentofacial, em tratamento ortodôntico pré-cirúrgico e um grupo controle constituído por 30 indivíduos com equilíbrio dentofacial, pareados segundo o gênero e a idade com o grupo deformidade. Para avaliação da articulação temporomandibular, foram aplicados o questionário anamnésico de disfunção temporomandibular e o Eixo 1 do Research Diagnostic Criteria for Temporomandibular Disorderspara verificar e classificar o grau e o tipo da disfunção temporomandibular, respectivamente.RESULTADOS:os resultados da aplicação do questionário demonstraram que o grupo com deformidade apresentou maior grau e escore da disfunção que o grupo controle (p<0,01). A partir do Research Diagnostic Criteria for Temporomandibular Disorders verificou-se maior ocorrência de diagnósticos de deslocamento de disco (p=0,02) e de artrite, artralgia e artrose (p<0,01) no grupo com deformidade em relação ao grupo controle.CONCLUSÃO:indivíduos com deformidade dentofacial apresentaram maior ocorrência de disfunção temporomandibular, quando comparados aos indivíduos com equilíbrio dentofacial, na amostra estudada.

Abstract:PURPOSE:to investigate the occurrence of temporomandibular dysfunction in subjects with dentofacial deformity.METHODS:60 subjects of both sexes and aged between 18 and 40 years (mean = 27 years) and formed two groups, one composed of 30 subjects with dentofacial deformity undergoing presurgical orthodontic treatment were evaluated and a control group consisted of 30 individuals with dentofacial balance, paired to dentofacial group, according to gender and age. Anamnestic questionnaire of temporomandibular dysfunction and Axis 1 of Research Diagnostic Criteria for Temporomandibular Disorders were applied, respectively, so as to verify and rate the degree and type of temporomandibular disorders.RESULTS:the results of the questionnaire demonstrated that dentofacial group presented a greater dysfunction degree and score than control group (p <0.01). From the Research Diagnostic Criteria for Temporomandibular Disorders, a greater occurrence of diagnoses involving disc displacement (p = 0.02) and arthritis, arthrosis and arthralgia (p <0.01) for dentofacial group, in relation to control group, was verified.CONCLUSION:individuals with dentofacial deformity had increased incidence of temporomandibular dysfunction, compared with individuals with dentofacial equilibrium, in the sample studied.

Changes in lower dental arch dimensions and tooth alignment in young adults without orthodontic treatment

OBJECTIVE: The aim of this longitudinal study, comprising young adults without orthodontic treatment, was to assess spontaneous changes in lower dental arch alignment and dimensions. METHODS: Twenty pairs of dental casts of the lower arch, obtained at different time intervals, were compared. Dental casts obtained at T1 (mean age = 20.25) and T2 (mean age = 31.2) were compared by means of paired t-test (p < 0.05). RESULTS: There was significant reduction in arch dimensions: 0.43 mm for intercanine (p = 0.0089) and intermolar (p = 0.022) widths, and 1.28 mm for diagonal arch length (p < 0.001). There was a mild increase of approximately 1 mm in the irregularity index used to assess anterior alignment (p < 0.001). However, regression analysis showed that changes in the irregularity index revealed no statistically significant association with changes in the dental arch dimensions (p > 0.05). Furthermore, incisors irregularity at T2 could not be predicted due to the severity of this variable at T1 (p = 0.5051). CONCLUSION: Findings suggest that post-growth maturation of the lower dental arch leads to a reduction of dental arch dimensions as well as to a mild, yet significant, increase in dental crowding, even in individuals without orthodontic treatment. Furthermore, dental alignment in the third decade of life cannot be predicted based on the severity of dental crowding at the end of the second decade of life. .

OBJETIVO: o objetivo deste trabalho foi avaliar, por meio de um estudo longitudinal em adultos jovens, sem tratamento ortodôntico, as alterações espontâneas do alinhamento da arcada dentária inferior e de suas dimensões. MÉTODOS: vinte pares de modelos de gesso da arcada inferior foram obtidos em dois tempos. No primeiro exame (T1), os indivíduos tinham, em média, 20,25 anos; enquanto no segundo exame (T2) a média de idade foi de 31,2 anos. Comparações entre os tempos T1 e T2 foram realizadas usando o teste t pareado (p < 0,05). RESULTADOS: houve uma redução significativa nas dimensões da arcada - de 0,43mm nas larguras intercaninos (p = 0,0089) e intermolares (p = 0,022) e de 1,28mm para o comprimento diagonal da arcada (p < 0,001). Foi observado um aumento suave, de aproximadamente 1mm, no índice de irregularidade anterior (p < 0,001). Entretanto, a análise de regressão mostrou que as mudanças no índice de irregularidade não revelaram uma associação estatisticamente significativa com as mudanças na arcada dentária (p > 0,05). Além disso, o índice de irregularidade dos incisivos em T2 não pode ser estimado, devido à severidade dessa variável em T1 (p = 0,5051). CONCLUSÃO: esses achados sugerem que a maturação da arcada dentária inferior, pós-crescimento, leva a uma redução das dimensões da arcada e um aumento suave, porém significativo, do apinhamento dentário, mesmo em indivíduos sem tratamento ortodôntico. Assim, o alinhamento dentário na terceira década de vida não pode ser previsto tendo como base a severidade do apinhamento dentário ao final da segunda década de vida. .

Manifestaciones clínicas del espectro óculo aurículo vertebral / Clinical manifestations of oculo auriculo vertebral spectrum

El Espectro óculo Aurículo Vertebral corresponde a un desorden heterogéneo y complejo que afecta el desarrollo de estructuras derivadas del primer y segundo arco branquial. Presenta un compromiso variable del macizo maxilofacial, condicionando el tratamiento de cada paciente a su expresión fenotípica. El objetivo de esta revisión de tema es describir las diversas características de este espectro. Para ello se realizó un análisis de la literatura científica con el fin de entregar una referencia actualizada sobre las principales manifestaciones clínicas, su diagnóstico, exámenes complementarios utilizados y posibles diagnósticos diferenciales. Dada su gran variabilidad, es de vital importancia que sea conocido no solo por el odontólogo, sino también por los equipos de salud, posibilitando la entrega de un diagnóstico oportuno a temprana edad y un manejo adecuado de las diferentes alteraciones que pueden presentar.

The Oculo Auriculo Vertebral spectrum corresponds to a heterogeneous and complex disorder that affects the development of structures derived from the first and second branchial arch. It has a variable commitment of maxillofacial structures , conditioning treatment for each patient to their phenotypic expression. The objective of this review article it's to describe various features of this spectrum . A scientific literature analysis was done with the aim of delivering an up to date reference regarding the main clinical manifestations, diagnosis, complementary exams used and possible differential diagnosis. Given its variable expression is that it becomes important to be known not only by the dentist, but also by health teams , allowing the delivery of timely early diagnosis and proper management of the different alterations that may present.

Craniofacial features of operated unilateral complete cleft lip and palate children: a case control study / Crescimento maxilo-mandibular em crianças com fissura unilateral completa de lábio e palato reparada: estudo caso controle

OBJECTIVE: To compare the craniofacial features of Brazilian children who had received surgery for unilateral complete cleft lip and palate compared with non-cleft group. METHODS: Craniofacial features were evaluated on lateral cephalometric radiographs. 46 patients with unilateral complete cleft lip and palate were divided by gender and matched at ages 6, 7, 8 and 9. They were compared with 46 non-cleft children, equally divided by gender and matched the same age groups. All comparisons were carried out by means of the Angles SNA, SNB and ANB. The findings were analyzed on the basis of the two-way Analysis of Variance (ANOVA) with p <0.05 significance level. RESULTS: Both the angle SNA and SNB in the cleft group had a lower average in both genders and all age groups compared with the non-cleft group (p<0.0001). The average values of ANB were significantly higher in the cleft group (p<0.05) both in males and females and in all age groups studied. CONCLUSION: Children who had received surgery for unilateral complete cleft lip and palate during childhood had maxillary and mandibular retrusion and a class II skeletal pattern in relation to non-cleft group. .

OBJETIVO: Comparar o crescimento ântero-posterior da maxila e da mandíbula entre pacientes com fissura unilateral completa de lábio e palato reparada e pacientes que não apresentavam nenhuma alteração craniofacial. MÉTODOS: Foram selecionadas 46 telerradiografias cefalométricas em norma lateral de pacientes com fissura unilateral completa de lábio e palato que foram submetidos às cirurgias primárias de correção durante a infância (grupo de estudo). A amostra do grupo controle foi composta por 46 telerradiografias cefalométricas em norma lateral de pacientes sem nenhuma alteração craniofacial e que apresentavam valores para os ângulos SNA e SNB dentro dos valores pré-estabelecidos de normalidade. O gênero e as faixas etárias entre 6 e 9 anos dos pacientes foram pareados e comparados em ambos os grupos. A comparação entre os dois grupos foi realizada por meio dos ângulos SNA, SNB e ANB. Aplicou-se a análise de variância (ANOVA), considerando-se o nível de significância de 5%. RESULTADOS: Observou-se diferença significativa entre os grupos de pacientes com fissura reparada e controle (p<0,0001), ou seja, o grupo com fissura reparada apresentou menor média de SNA e SNB em todas as idades. Para o ângulo ANB, o grupo com fissura reparada apresentou maior média em todas as faixas etárias (p<0,05). CONCLUSÃO: Pode-se concluir que o grupo de pacientes com fissura unilateral completa de lábio e palato reparada nas faixas etárias estudadas e em ambos os gêneros apresentaram maxila e mandíbula retruídas em uma relação esquelética de Classe II em relação ao grupo controle. .

Qual a idade adequada para colocação de implante dentário osseointegrável? / What is the appropriate age for dental implant placement?

A ausência de um dente pode causar problemas funcionais, estéticos e emocionaisa um paciente. Há mais de três décadas, os implantes osseointegráveis têm sido utilizadoscomo método alternativo para reposição de dentes perdidos, uma vez que apresentam um bom desempenhoem longo prazo. Implantes dentários unitários são colocados em muitos pacientes jovens,porém, pequenas mudanças na posição da margem gengival podem comprometer o resultado estéticodessas reabilitações. Implantes geram retardo no desenvolvimento dentoalveolar vertical, porisso são comparados a dentes anquilosados por diversos autores, já que não irrompem juntamentecom os dentes adjacentes. Isso significa que, em pacientes que ainda possam crescer, as prótesesimplantossuportadas podem ficar em infraoclusão. Como diversos autores relatam crescimentoapós a adolescência, essa revisão de literatura teve como objetivo indicar o momento mais adequadopara a colocação de implantes osseointegráveis, considerando o crescimento craniofacialresidual...

The absence of a tooth may cause functional, esthetic and emotional problemsto a patient. For more than three decades, osseointegrated implants have been used as an alternativemethod to replace missing teeth, as they have shown good long-term results. Single toothimplants are placed in many young patients, but slight changes in position of the gingival marginmay compromise the esthetic outcomes of such rehabilitations. Implants retard vertical dentoalveolardevelopment, for this reason, they are compared to ankylosed teeth by many authors, as theydo not erupt together with adjacent teeth. In the case of patients that could still grow up, that meansthe implant-supported prostheses may result in infra-occlusion. Objective: Since a variety of authorsreport post-adolescent growth, this literature review aimed to indicate the most adequatemoment for osseointegrated implant placement, taking into account residual craniofacial growth...

O impacto da septoplastia Metzembaum sobre o crescimento nasal e facial em crianças / The impact of Metzembaum septoplasty on nasal and facial growth in children

Há vários estudos que investigaram os efeitos da septoplastia no crescimento facial em crianças, com resultados conflitantes. No entanto, poucos empregaram medidas objetivas ou avaliaram os pacientes após o término do crescimento facial. OBJETIVO: Este estudo avalia os efeitos da septoplastia Metzenbaum, que preserva o pericôndrio e áreas relacionadas com o crescimento, sobre o crescimento nasal e facial em crianças. MÉTODO: Crianças que foram operadas antes dos 14 anos e que apresentavam 16 anos ou mais na avaliação foram incluídas. Dezesseis pacientes foram selecionados. Os seguintes parâmetros foram avaliados: satisfação clínica (patência e estética nasal); medidas antropométricas; cefalometria. Desenho científico: estudo de coorte histórica com corte transversal. RESULTADOS: A idade média na cirurgia foi de 13 anos; as crianças foram avaliadas em média 4,3 anos após a cirurgia. Apenas um paciente apresentou medidas antropométricas e cefalométricas abaixo da normalidade, porém, sem queixas quanto à estética ou à patência. Outros quatro pacientes apresentaram queixa quanto à estética nasal e três quanto à patência nasal. CONCLUSÃO: A septoplastia Metzenbaum parece ser uma técnica segura na correção de desvios caudais. Esta técnica não apresentou impacto significativo no crescimento facial dos pacientes avaliados.

Several studies have investigated the effects of septoplasty on facial growth in children, with conflicting results. However, just handful of those employed objective measures or evaluated patients after facial growth completion. OBJECTIVE: This study assesses the effects of the Metzenbaum septoplasty, which preserves the perichondrium and growth-related areas on nasal and facial growth in children. METHOD: We included those children submitted to surgery before the age of 14 and who had 16 years or years of follow up. Sixteen patients were selected. We evaluated the following parameters: clinical satisfaction (nasal patency and aesthetics), anthropometric measurements and cephalometry. Scientific design: cross-sectional historical cohort. RESULTS: The mean age at surgery was 13 years, children were assessed on average 4.3 years after surgery. Only one patient had anthropometric and cephalometric values below normal, but no aesthetics or patency complaints. Four other patients complained about their nasal aesthetics and three had patency complaints. CONCLUSION: The Metzenbaum septoplasty appears to be a safe technique to correct caudal septum deviations. This technique had no significant impact on facial growth of the patients assessed.

Transverse maxillary and mandibular growth during and after Bionator therapy: study with metallic implants

INTRODUCTION: This study evaluated posteroanterior cephalograms before and after treatment and long term follow-up of Class II division 1 patients treated with bionator. OBJECTIVE: The objective was to demonstrate the transverse growth of maxilla and mandible during and after bionator therapy. METHODS: Measurement of transverse dimensions between posterior maxillary and mandibular implants, as well as the distances between the buccal, gonial and antegonial points were recorded. Measurements were analyzed at three periods: T1 = before bionator therapy, T2 = after bionator therapy and T3 = 5.74 years after T2. RESULTS: There was statistically significant transverse increase due to growth and/or treatment for all variables, except for the distance between the anterior maxillary implants. CONCLUSIONS: During the study period only the anterior maxillary area did not show transverse growth.

INTRODUÇÃO: esse estudo envolve a avaliação de telerradiografias posteroanteriores pré- e pós-tratamento com Bionator, bem como, em longo prazo, de pacientes Classe II divisão 1. OBJETIVO: o objetivo desse trabalho é demonstrar o crescimento transversal da maxila e mandíbula durante e após o uso do Bionator. MÉTODOS: as mensurações das distâncias transversais entre os implantes posteriores da maxila e mandíbula, bem como as das distâncias entre os pontos jugal, gônio e antigônio, foram tomadas em três tempos: T1, antes da terapia com Bionator; T2, após a terapia como Bionator; e T3, 5,74 anos após T2. RESULTADOS: ocorreu aumento transversal estatisticamente significativo por crescimento e/ou por tratamento em todas as variáveis estudadas, com exceção da distância entre os implantes anteriores da maxila. CONCLUSÕES: durante o período do estudo, somente a região anterior da maxila não apresentou crescimento transversal.