Relación del plano oclusal con la altura del ángulo goníaco y proyección del mentón / Relation of the occlusal plane with the height of the gonial angle and projection of the chin

Introducción: hemos observado en nuestra práctica ortodóncica una gran cantidad de pacientes con plano oclusal inclinado, con un ángulo goníaco alto y postero-rotación mandibular. Todo parece indicar que el plano oclusal juega un papel muy importante en el desarrollo de las maloclusiones. Objetivo: mostrar en el presente caso clínico de un niño, si existe una correlación entre la inclinación del plano oclusal, la altura del ángulo goníaco, la longitud de la rama mandibular y la proyección del mentón antes y después, al corregirlo y hacerlo más horizontal con tratamiento ortodóncico. Caso clínico: paciente masculino de 11 años de edad, hiperdivergente, clase II esquelética severa, perfil convexo, apiñamiento dental superior e inferior, clase II molar, incompetencia labial severa, mordida profunda, overjet aumentado, mentón retrusivo, cervicales rectificadas y anterorotación de cabeza. El tratamiento de ortodoncia se realizó con brackets Roth slot 22 y extracciones de primeros premolares superiores e inferiores y primeros molares superiores (siendo reemplazados por los terceros molares superiores), curvas inversas, cierre de espacios con pérdida de anclaje y ajuste oclusal. Resultados: al finalizar el tratamiento, se logró mejorar la estética facial, un ángulo goníaco más desarrollado con mayor crecimiento vertical, mayor proyección del mentón, un plano oclusal más horizontal, un adecuado overbite y overjet, clase I molar y canina, antero-rotación mandibular, buena intercuspidación, oclusión funcional y excelente estabilidad oclusal sin retención, mejoría en lordosis cervical y posición de la cabeza. Conclusiones: la corrección de un plano oclusal inclinado en niños y adolescentes hiperdivergentes, puede mejorar de manera importante el vector de crecimiento, ayudar a un mayor desarrollo en la altura del ángulo goníaco y longitud de la rama mandibular, proyección del mentón al corregirlo y hacer el plano oclusal más horizontal con la mecánica ortodóntica de curvas inversas; por lo tanto, en el presente caso clínico: sí existe una correlación muy importante entre la inclinación del plano oclusal, la altura del ángulo goníaco y la proyección del mentón antes y después del tratamiento ortodóncico (AU)

Introduction: we have observed in our orthodontic practice a large number of patients with inclined occlusal plane, with a high goniac angle and posterior mandibular rotation. Everything seems to indicate that the occlusal plane plays a very important role in the development of malocclusions. Objective: to show in the present clinical case of a child, if there is a correlation between the inclination of the occlusal plane, the height of the goniac angle, the length of the mandibular branch and the projection of the chin before and after, when correcting it and making it more horizontal with orthodontic treatment. Case report: an 11 year old male patient, hyperdivergent, severe skeletal class II, convex profile, upper and lower dental crowding, molar class II, severe labial incompetence, deep bite, increased overjet, retrusive chin, rectified cervicals, and anterorotation of the head. Orthodontic treatment was performed with Roth slot 22 brackets and extractions of upper and lower first premolars and upper first molars (being replaced by upper third molars), inverse curve, space closure with loss of anchorage and occlusal adjustment. Results: at the end of the treatment, it was possible to improve facial aesthetics, a more developed gonial angle with greater vertical growth, greater chin projection, a more horizontal occlusal plane, an adequate overbite and overjet, molar and canine class I, mandibular anterorotation, good intercuspidation, functional occlusion and excellent occlusal stability without retention, improvement in cervical lordosis and head position. Conclusions: the correction of an inclined occlusal plane in hyperdivergent children and adolescents can significantly improve the growth vector, help further development in the height of the gonial angle and length of the mandibular ramus, chin protection when correcting it and making the most horizontal occlusal plane with the orthodontic mechanics of inverse curves; therefore, in the present clinical case: there is a very important correlations between the inclination of the occlusal plane, the height of the gonial angle and chin projection before and after orthodontic treatment (AU)

Expansión dentoalveolar predecible en Ortodoncia con uso de alineadores. Reporte de un caso clínico / Predictable dentoalveolar expansion in orthodontics with the use of aligners. Case Report

Este artículo describe el caso clínico de una paciente de 49 años. Clínicamente se observa Clase II molar derecha, Clase I molar izquierda y Clase I canina de ambos lados. La línea media superior se encuentra desviada hacia el lado izquierdo. Ausencia de piezas 35 y 45. Estrechez de maxilar superior con apiñamiento posterior izquierdo y derecho, apiñamiento anteroinferior. Mordida invertida posterior bilateral. Corredores bucales amplios. Sonrisa consonante, media. Para su tratamiento se indica una primera etapa de 13 alineadores con movimientos de traslación a vestibular y movimientos de torque coronovestibular, donde se planifica una expansión del maxilar superior de 10,99 mm. Al cabo de ocho meses de tratamiento, se observan 5,5 mm de expansión posterior logrados en esta primera etapa. Puede afirmarse que los alineadores son una herramienta efectiva para producir expansión del arco dental. La previsibilidad resultó razonable para el movimiento de expansión con el uso de alineadores.

This article describes the clinical case of a 49 year old female patient. Clinically, right molar class II, left molar class I, and canine class I are observed on both sides. Upper midline deviated to the left side, absence of teeth 35 and 45. Narrowness of the upper jaw with left and right posterior crowding, anteroinferior crowding. Bilateral posterior reverse bite. Negative space. Consonant, medium smile. For its treatment, a first stage of 13 aligners with buccal translation movements and coronobuccal torque movements is indicated, where an expansion of the upper jaw of 10.99 mm is planned. After 8 months of treatment, we can observe 5.55 mm of posterior expansion achieved in this first stage. We can affirm that aligners are an effective tool to produce expansion of the dental arch. Predictability was reasonable for the expansion movement with the use of aligners.

Nuevas herramientas en el tratamiento de la Clase II con alineadores / New tools in the treatment of Class II with aligners

La maloclusión de Clase II es una de las disarmonías esqueléticas más frecuentes en la población caucásica con una alta prevalencia de retrusión mandibular (aproximadamente el 80% de los casos). Es una situación clínica compleja que no solo implica problemas estéticos, alteraciones en plano sagital, sino que también se asocia a diversas condiciones que requieren nuestra atención, como relación transversal maxilar, respiración bucal, apnea del sueño, deglución atípica, anomalías del aparato visual y malos hábitos orales o signos y síntomas de trastorno de la articulación temporomandibular (ATM). Es importante estudiar y evaluar el momento óptimo de tratamiento del paciente para maximizar su eficacia. La evidencia científica demuestra que el momento óptimo es el estirón prepuberal del paciente, momento al que hasta ahora se podía acceder con los diferentes protocolos de alineadores. El protocolo A6 se puede utilizar desde la dentición primaria, lo que permite aprovechar el primer pico de crecimiento entre los 5 y 7 años, cuando erupcionan los 1º molares permanentes y se puede crear un nuevo plano oclusal correcto que favorezca los movimientos mandibulares, y corregir la dinámica anteroposterior y vertical, abriendo un nuevo camino en la corrección temprana de las maloclusiones.

Class II malocclusion is one of the most frequent skeletal disharmonies in the Caucasian population with a high prevalence of mandibular retrusion, approximately 80% of cases. It is a complex clinical situation that not only involves esthetic problems, or occlusion of the teeth in the sagittal plane, but is also associated with various conditions that require our attention, such as maxillary transverse relationship, mouth breathing, sleep apnea, atypical swallowing, visual apparatus anomalies and bad oral habits or signs and symptoms of TMJ disorder. It is important to study and evaluate the optimal timing of patient treatment to maximize the efficacy of treatment. Scientific evidence shows that the optimal time is the patient's prepubertal growth spurt, a time that until now we could access with the different aligner protocols. The A6 protocol can be used from the primary dentition, which allows us to take advantage of the first growth peak between 5 and 7 years of age, when the 1st permanent molars erupt and we can create a new correct occlusal plane that favors mandibular movements and correct anteroposterior and vertical dynamics, opening a new path in the early correction of malocclusions.

Insulin-Like Growth Factor-1 and Insulin-Like Growth Factor Binding Protein-3 - Biomarkers for Skeletal Maturity Assessment in Class II Malocclusion

ABSTRACT Objective: To estimate the serum levels of non-radiologic biomarkers, Insulin-like Growth Factor-1 (IGF-1), and Insulin-like Growth Factor Binding Protein-3 (IGFBP-3) to potentially identify the pubertal growth spurt in skeletal Class II malocclusion subjects. Material and Methods: Eighty subjects (M-38, F-42) with skeletal Class II malocclusion in the age range of 11-18 years were recruited for the cross-sectional study. Human serum IGF-1 and IGFBP-3 were quantitatively assessed by enzyme-linked immunosorbent assay, and the cervical stage (CS) was evaluated from a lateral cephalogram. Results: Gender-wise comparison of the mean serum IGF-1 levels revealed that the initial peak was detected at CS2 in both genders, [males (87.87 ng/mL), females (78.49 ng/mL)]. However, there was a cognizable difference in the second peak of the mean serum IGF-1 levels between males (CS5, 68.58 ng/mL) and females (CS4, 74.63 ng/mL). Mean IGFBP-3 serum levels in male subjects were high in CS4 (47.24 ng/mL) with a further spike in CS6 (50.54 ng/mL), and in female subjects, it was found to be highest in CS3 (51.95 ng/mL) and then in CS5 (49.68 ng/mL). Conclusion: Mean IGF-1 levels exhibited both sexes' prepubertal and late pubertal spikes. Mean IGFBP-3 levels revealed a pubertal and a late pubertal spike in both sexes, with an earlier growth trend observed specific to females compared to males.

A relevância da odontologia na Síndrome Treacher Collins: relato de caso / The relevance of dentistry in Treacher Collins Syndrome: case report

Treacher Collins também chamada de disostose mandibulofacial, é uma alteração genética dominante rara caracterizada pela má-formação dos ossos e tecidos da face. É uma síndrome crânio-facial que apresenta alterações bilaterais e simétricas de estruturas originadas do primeiro e segundo arcos branquiais. A maioria dos casos possui transmissão autossômica dominante e expressividade variável. O objetivo do presente estudo é realizar um relato de caso sobre o impacto do tratamento odontológico na qualidade de vida do paciente portador de Treacher Collins. Paciente, 39 anos, sexo feminino compareceu a uma clínica odontológica em Belo Horizonte, com a queixa principal de falhas dentárias e sensibilidade. Durante a anamnese a paciente relatou ter a STC, durante o exame clínico extraoral verificou a presença de hipoplasia malar e mandibular, malformação dos pavilhões auriculares com perda auditiva, obliquidade e coloboma palpebral inferior. Ao exame intraoral observou ser classe II de Angle, ausência dos dentes 11, 12, 13, 21 e 22 e extrusão do dente 41 e recessão gengival e periodontite estágio I grau A. Após exames de periodontograma e complementares foi realizado uma raspagem nas áreas com profundidade de sondagem maior que 3mm, frenectomia labial inferior, aplicação de laser para sensibilidade, enxerto gengival e colocação de prótese parcial removível. A paciente ao final do tratamento relatou ter se sentido realizada e contente com a sua conclusão, ela foi encaminhada ao Sistema único de Saúde para realizar as cirurgias para corrigir as alterações crânio-faciais. O tratamento odontológico deve ser adaptado a cada indivíduo de acordo com sua necessidade, tendo uma abordagem multidisciplinar, possibilitando uma melhora na qualidade de vida e estética do paciente(AU)

Treacher Collins syndrome is a rare dominant genetic disorder characterized by malformation of the bones and tissues of the face. It is a craniofacial syndrome that presents bilateral and symmetrical alterations of structures originating from the first and second branchial arches. The aim of the present study is to perform a case report on the impact of dental treatment on the quality of life of a patient with CTS. Patient, 39 years old, female, attended a dental clinic in Belo Horizonte, with the main complaint of dental flaws and sensitivity. During the anamnesis the patient reported having CTS, during the extraoral clinical examination she verified the presence of malar and mandibular hypoplasia, malformation of the pinnae with hearing loss, obliquity and lower eyelid coloboma. Intraoral examination revealed Angle class II, missing teeth 11, 12, 13, 21 and 22, extrusion of tooth 41, gingival recession and stage I periodontitis grade A. After periodontogram and complementary exams it was performed a scaling in areas with a probing depth greater than 3mm, lower lip frenectomy, laser application for sensitivity, gingival graft and placement of partial removable prosthesis. The patient at the end of treatment reported feeling fulfilled and happy with its completion, she was referred to the Unique Health System to undergo surgery to correct the craniofacial changes. The current treatment aims at functional and aesthetic correction and the need for psychosocial support, having the joint participation of a multidisciplinary team to achieve this goal(AU)

Effect of Bimaxillary Orthognathic Surgery on Pharyngeal Airway Volume / Efecto de Cirugía Ortognática Bimaxilar en el Volumen de la Vía Aérea Faríngea

SUMMARY: Subjects with maxillary skeletal classes II and III not only express alterations in the hard and soft maxillofacial tissues, but also in the morphology and dimensions of the upper airway. A small space in the upper airway has been associated with sleep disorders, such as snoring and mainly obstructive sleep apnea/hypopnea syndrome (OSAHS). Consequently, interest has increased due to the influence of orthognathic surgery in the airway space. Although there are studies in the literature that have compared upper airway spaces, most have evaluated the changes using two-dimensional images, mainly lateral skull X-rays. The present study aimed to determine the airway volume in subjects with skeletal classes II and III who underwent bimaxillary orthognathic surgery. 80 CBCT exams from 40 subjects obtained before and 6 months after surgery were used. There were 20 class II and 20 class III subjects. For the volumetric analysis, a 3D rendering of the upper airway was made in previously established segments, and then the airway volume was calculated using the 3D Slicer® software version 4.11 (Slicer, USA). The statistical analysis by t-test of related samples revealed statistically significant volumetric increases in the nasopharynx, laryngopharynx, and total volume in class II patients. However, in class III patients, there were significant increases in the nasopharynx and total volume, while the volume was maintained in the oropharynx and laryngopharynx.

Sujetos con clases esqueletales II y III maxilares, no solamente expresan alteraciones en los tejidos duros y blandos maxilofaciales, sino también en la morfología y dimensiones de la vía aérea superior. Un espacio reducido a nivel de la vía aérea superior se asocia a trastornos del sueño como ronquidos y principalmente el síndrome de apnea/hipoapnea obstructiva del sueño (AOS); debido a esto, ha aumentado el interés por la influencia de la cirugía ortognática en el espacio de la vía aérea. Si bien existen en la literatura estudios que han comparado los espacios de la vía aérea superior, la mayoría de los estudios han evaluado los cambios utilizando imágenes bidimensionales, principalmente radiografías laterales de cráneo. El objetivo del presente estudio fue determinar el volumen de la vía aérea en sujetos con clases esqueletales II y III sometidos a cirugía ortognática bimaxilar. Se utilizaron 80 exámenes CBCT pertenecientes a 40 sujetos obtenidos previo a la cirugía y 6 meses después de realizada. Veinte sujetos clase II y 20 clase III. Para el análisis volumétrico se realizó un renderizado 3D de la vía área superior en segmentos previamente establecidos y posteriormente se calculó el volumen de dicha vía aérea con la utilización del software 3D Slicer ®versión 4.11 (Slicer, USA). El análisis estadístico realizado por t-test de muestras relacionadas, arrojó en pacientes clase II aumentos volumétricos estadísticamente significativos en nasofaringe, laringofaringe y volumen total. Mientras que en pacientes clase III, se observó aumentos significativos en Nasofaringe y volumen total y mantención de volumen en orofaringe y laringofaringe.

Resolución de caso clínico de Clase II sin extracciones. "De Clase II a Clase I sin escalas y solo con resorte", filosofía CCO / Resolution of Class II clinical case without extractions. "From Class II to Class I without scales and only with spring", CCO philosophy

Como hemos visto, la Odontología ha evolucionado constantemente con el paso de los años, y por supuesto la Ortodoncia ­magníficamente desarrollada por el Dr. Angle­ y los brackets diseñados desde hace décadas no son la excepción, ya que han sufrido muchas modificaciones al día de la fecha. Hemos pasado por un sinnúmero de cambios, prescripciones, conceptos que nos brindan un amplio abanico de posibilidades, siempre en busca de lo mejor para nuestros pacientes y para nosotros, disminuyendo los tiempos de tratamiento y también el tiempo de sillón, que no es un tema menor. Este caso de revisión clínica confirma que podemos hacer ortodoncias eficientes y simples con excelentes resultados y en corto plazo.

As we have seen, dentistry has constantly evolved over the years, and of course orthodontics is no exception, from the braces designed in the 30s to date we have gone through a number of changes, prescriptions , concepts and modifications that offer us a wide range of possibilities, always looking for the best for our patients and for us, reducing chair times. This clinical review case confirms that we can do efficient and simple orthodontics with excellent results and in the short term.

Análisis bidimensional de la permeabilidad de vías aéreas con el tamaño de senos maxilares y su relación con el desarrollo de la clase esqueletal en una población mexicana / Two-dimensional analysis of airway permeability with maxillary sinus size and its relationship with the development of skeletal class in a Mexican population

Comparar la permeabilidad de las vías aéreas y el tamaño de los senos maxilares en relación con la clase esqueletal. se midieron 90 radiografías lateral de cráneo, divididas en 3 grupos, comparando las 3 clases esqueletales, las cuales se determinaron con la medida ANB de Steiner, y estas a su vez en dos subgrupos que fueron hombres y mujeres, en las cuales se utilizó el análisis de McNamara para el análisis de vías aéreas y para el área del seno maxilar se tomaron dos medidas una antero-posterior y cefálica-caudal. Al comparar los hombres con las mujeres se identificó significancia estadística en vía área superior de clase II (p=≤0.017), vía aérea inferior de clase III (p=≤0.006). Al comparar las clases esqueletales en hombres se identificó diferencias en la vía aérea superior en las clases I vs III (p=≤0.05), inferior en la clase I vs III (p=≤0,001) y II vs III (p=≤0.044). Con respecto a mujeres se identificó significancia en la vía aérea superior al comparar la clase I vs II (p=≤0,043), vía aérea inferior en la clase II vs III (p=≤0.05), longitud del seno maxilar al comparar clase I vs II (p=≤0.017). Entre la clase I esqueletal y la clase II, el tamaño de los senos maxilares resulto menor en longitud en las mujeres de clase II esqueletal. Entre la clase I y clase III esqueletal en hombres, se encontró una longitud menor en la vía aérea superior e inferior en la clase I. Las vías aéreas resultaron en menor tamaño en sujetos de clase II.

SUMMARY: To compare the airway permeability and the size of the maxillary sinuses in relation to the skeletal class. 90 lateral skull radiographs were divided into 3 groups, comparing the 3 skeletal classes, which were determined with Steiner's ANB measurement, and these were once in two subgroups that were men and women, in any McNamara analysis was used for the analysis of airways and for the maxillary sinus area measurements were made an antero-posterior and cephalic-caudal. When comparing males with females, statistical significance was identified in the upper class II route (p=≤0,017), lower class III airway (p=≤0.006). At least skeletal classes in men, differences were identified in the upper airway in classes I vs III (p=≤0.05), lower in class I vs III (p=≤0.001) and II vs III (p=≤0.044). With respect to women, significance was identified in the upper airway when comparing class I vs II (p=≤0.043), lower airway in class II vs. III (p=≤0.05), maxillary sinus length to class I vs II (p=≤0.017). Between skeletal class I and class II, maxillary sinus size was shorter in length in skeletal class II women. Between class I and skeletal class III in men, a lower length was found in the upper and lower airways in class I. The airways were found to be smaller in class II subjects.

Decompensation effectiveness and alveolar bone remodeling analysis of mandibular anterior teeth after preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusion / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the decompensation effectiveness and alveolar bone remodeling of mandibular anterior teeth after preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusion using lateral cephalogram and cone-beam computed tomography (CBCT).@*METHODS@#Thirty high-angle patients with skeletal class Ⅱ malocclusion who had received preoperative orthodontic treatment and orthognathic surgery in Peking University School and Hospital of Stomatology between Ja-nuary 2017 and August 2022 and had taken lateral cephalogram and CBCT before and after preoperative orthodontic treatment were selected. Items were measured with lateral cephalogram including: The lower central incisor (L1)-Frankfort plane angle (L1-FH), the L1-mandibular plane angle (L1-MP), the L1-nasion-supramental angle (L1-NB) and the vertical distance from the incisal edge of lower central incisor to NB line (L1-NB distance), etc. The incidence of dehiscence/fenestration and the length of dehiscence at labial side (d-La) and lingual side (d-Li) were measured using CBCT. Pearson correlation analysis was used to evaluate the correlation between the changes of d-Li of L1 and age, duration of preoperative orthodontic treatment and the cephalometric measurements before preoperative orthodontic treatment to screen out risk factors affecting the periodontal risk of preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusions.@*RESULTS@#After preoperative orthodontic treatment, L1-FH, L1-MP, L1-NB and L1-NB distances changed by 11.56°±5.62°, -11.13°±5.53°, -11.57°±5.43° and (-4.99±1.89) mm, respectively, and the differences were all statistically significant (P < 0.05). Among the 180 measured mandibular anterior teeth, 45 cases with labial dehiscence/fenestration before preoperative orthodontic treatment (T0) had no longer labial dehiscence/fenestration after preope-rative orthodontic treatment (T1); 142 cases without lingual dehiscence/fenestration at T0 had lingual dehiscence/fenestration at T1. After preoperative orthodontic treatment, the d-La of lower lateral incisors (L2), lower canines (L3) and lower anterior teeth (L1+L2+L3) decreased by (0.95±2.22) mm, (1.20±3.23) mm and (0.68±2.50) mm, respectively, and the differences were statistically significant (P < 0.05); the d-Li of L1, L2, L3 and L1+L2+L3 increased by (4.43±1.94) mm, (4.53±2.35) mm, (3.19±2.80) mm and (4.05±2.46) mm, respectively, and the differences were statistically significant (P < 0.05). The increase of d-Li of L1 was positively correlated with L1-FH (r=0.373, P=0.042).@*CONCLUSION@#This study showed that high-angle patients with skeletal class Ⅱ ma-locclusion could achieve ideal decompensation effect of mandibular anterior teeth after preoperative orthodontic treatment with bilateral mandibular first premolars extracted, but the lingual periodontal risk of mandibular anterior teeth was increased. This risk could be correlated to L1-FH before preoperative orthodontic treatment, which should be paid more attention in the design of orthodontic-orthognathic surgical treatment.

Mandibular advancement with clear aligners and functional appliances in the treatment of skeletal ClassⅡmalocclusion: a systematic review and meta-analysis / 华西口腔医学杂志

OBJECTIVES@#This study aimed to conduct a meta-analysis of the efficacy of mandibular advance clear alig-ners with traditional functional appliances as the control group.@*METHODS@#PubMed, Web of Science, Embase, Cochrane Library, China Biomedical Abstracts Database, China Knowledge Network Database, Wanfang Database, and Weipu Database were used in this study. The two groups of researchers screened the literature and extracted data based on the inclusion and exclusion criteria established by PICOS entries, and used the ROBINS-I scale for quality evaluation. Revman 5.4 and Stata 17.0 software were used for meta-analysis.@*RESULTS@#Nine clinical controlled trials were included in this study with a total sample size of 283 cases. No significant difference was found in SNA, SNB, ANB, Go-Pog, U1-SN, Overjet, and other aspects between the invisible group and the traditional group in the treatment of skeletal class Ⅱ ma-locclusion patients; there was a 0.90° difference in mandibular plane angle between the two groups; the growth of the mandibular ramus (Co-Go) in the traditional group was 1.10 mm more than that in the invisible group; the lip inclination of the lower teeth in the invisible group was better controlled, 1.94° less than that in the control group.@*CONCLUSIONS@#The invisible group can better control the lip inclination of the mandibular anterior teeth when guiding the mandible. Furthermore, the mandibular plane angle (MP-SN) can remain unchanged, but the growth of the mandibular ramus is not as good as the traditional group, and auxiliary measures should be taken to improve it in clinical practice.

Meta-analysis of condylar changes produced by a Twin-block appliance in Class Ⅱ malocclusion / 华西口腔医学杂志

OBJECTIVES@#To evaluate the effects of a Twin-block appliance on the condyles of patients with ClassⅡmalocclusion by conducting a systematic review and a Meta-analysis.@*METHODS@#Pubmed, Embase, Cochrane Library, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, and VIP Database were electronically searched. Randomized controlled trials, controlled clinical trials, and single-arm trials on condylar changes produced by a Twin-block appliance in patients with ClassⅡmalocclusion were included. Two reviewers independently extracted and assessed the risk of bias. Meta-analyses were conducted with Review Manager 5.3.@*RESULTS@#Eight studies were included; among which, seven were of high quality. After treatment with a twin block appliance, condyles moved anteriorly. The anterior joint spaces decreased (P<0.000 01), whereas the posterior spaces increased (P<0.000 01). The superior spaces were not changed (P=0.11). Moreover, a significant difference was observed in the increase of the condylar space index (P<0.000 01). After treatment, the anteroposterior diameters of the condyles and condylar height increased (P=0.000 2 and P<0.000 01, respectively). By contrast, no significant changes were discovered in the medial external diameters of the condyles (P=0.42).@*CONCLUSIONS@#A Twin-block appliance can promote the growth of a condyle in the posterior and upper direction and move it forward in favor of the correction of Class Ⅱ malocclusion.

Angle class II/2nd division: is there an alignment? / Classe II/2ª divisão de Angle: existe alinhamento?

Introduction: Interdisciplinary investigative study of the stomatognathic-cervical complex, necessary to understand the structure and biomechanics of this system in Angle Class I and II / 2nd Division participants. Objective: To evaluate alignment and position of cranial cervical structures on radiographs and their functional relationship with the stomatognathic system. Material and method: Trans Oral and Profile radiographs were submitted to biomechanical analysis, considered the linear and angular measurement of Atlas and Axis through the application included in the radiogram software. Result: We observed a significant difference in the angular measurements of vertical alignment between the Skull, Axis, and the Mandible (p = <0.001), and in the left joint between the Atlas and the Axis (AE: p = 0.011; SEA: p = 0.042). Among the linear measures of the distances between the Atlas and the Axis, the AOD distance presented statistics quite close to the level of significance (p = 0.0502), but above. There was no statistically significant difference in the other measures. Conclusion: In this study, the alignment between the Atlas and Axis cervical vertebrae and the mandible and angles of the atlanto-occipital joints are altered in Class II / 2nd Division participants. There is no difference in the size and distance of the Atlas and the Axis between the Classes.

Introdução: Estudo interdisciplinar investigativo do complexo cérvico-estomatognático, necessário para compreender a estrutura e a biomecânica desse sistema em participantes Classe I e II/2ª Divisão de Angle. Objetivo: Avaliar o alinhamento e a posição das estruturas crânio cervicais nas radiografias de participantes Classe I e II/2ª Divisão de Angle e sua relação funcional com o sistema estomatognático. Material e método: As imagens digitais Trans Oral e Perfil de participantes com maloclusão Classe I e II/2ª Divisão de Angle foram submetidas à medição linear e angular do crânio, mandíbula, Atlas e do Áxis através do software Advantage Workstation 4.6 (AW4.6 ext. 04). Resultado: Houve diferença significativa nas medidas angulares de alinhamento vertical entre o Crânio, Áxis e a Mandíbula (p = <0,001), e da articulação esquerda entre o Atlas e o Áxis (AE: p = 0,011; AAE: p = 0,042). Das medidas lineares das distâncias entre o Atlas e o Áxis, a distância AOD apresentou estatística bastante próxima do nível de significância (p=0,0502), porém acima. Não houve diferença significativamente estatística nas demais medidas avaliadas. Conclusão: Neste estudo, o alinhamento entre as vértebras cervicais Atlas e Áxis e a mandíbula e os ângulos das articulações atlanto occipitais se mostraram alterados nos participantes Classe II/2ª Divisão de Angle. Não há diferença significativa no tamanho e distância do Atlas e do Áxis entre as Classes.

Uso del twin-block en niños de 5 a 12 años con maloclusión Clase II y III. Revisión de la literatura / Use of the twin-block in patients aged 5 to 12 years with class II and III malocclusion. Literature Review

Introducción: las maloclusiones Clase II y III pueden ser tratadas desde edades tempranas y su manejo oportuno incluye el reconocimiento, diagnóstico y tratamiento adecuado. Desde la visión ortopédica, teniendo en cuenta la presencia de momentos de crecimiento y desarrollo, podrían planificarse diversas aparatologías removibles, ortopédicas, miofuncionales y/o fijas. El twin-block está constituido por bloques de mordida superior e inferior con un plano inclinado que dirige la fuerza de oclusión a fomentar la función mandibular normal. Objetivo: efectuar una revisión de la literatura sobre el uso del twin-block y su efectividad en pacientes de 5 a 12 años con maloclusión Clase II y III. Métodos: se realizó una revisión de literatura en las bases de datos electrónicas en inglés PUBMED/MEDLINE, Elsevier, Epistemonikos y Google Schoolar; y en idioma español, imbiomed. org, Scielo.org y Google académico. Se incluyeron un total de 16 artículos. Los años límites para la búsqueda fueron enero de 2011 a junio de 2022. La revisión abarcó aspectos referidos al uso del twin-block en niños con maloclusión Clase II y III. Resultados: los estudios reportaron resultados favorables al uso efectivo del twin-block para la corrección de las maloclusiones, con cambios esqueléticos y dentoalveolares en dentición permanente y mixta. Conclusiones: la evidencia científica revisada sugiere que el uso del twin-block es efectivo en pacientes pediátricos con maloclusión Clase II o III.

Introduction: Class II and III malocclusions could be treated from early ages and their timely management includes recognition, diagnosis and adequate treatment; this from the orthopedic view due to the presence of moments of growth and development, various removable, orthopedic, myofunctional and/or fixed appliances could be planned. The twinblock consists of upper and lower bite blocks with an inclined plane that directs the occlusal force to promote normal mandibular function. Objective: To review the literature on the use of the twin-block in patients 5 to 12 years of age with class II and III malocclusion. Methods: A descriptive, retrospective research was carried out in the electronic databases PUBMED/MEDLINE, Elsevier, Epistemonikos and Google Scholar; and in the Spanish language imbiomed.org, Scielo.org and Google Scholar a total of 16 articles were included. The years for the search were January 2011 to June 2022. The review covered aspects referring to the effectiveness of the use of the twin-block in children with type II and III malocclusion. Results: The studies reported favorable results for the effective use of the twin-block for the correction of malocclusions producing skeletal and dentoalveolar changes in permanent and mixed dentition. Conclusions: The scientific evidence reviewed suggests that the use of the twin-block is effective in pediatric patients with class II or III malocclusion

Tratamiento de Clase II, en dentición permanente, con péndulum Pend-X y anclaje esqueletal / Class II treatment, in permanent dentition, with Pend X and skeletal anchorage

El aspecto estético y, en especial, la protrusión marcada, a menudo alientan a los pacientes a so- licitar tratamiento de ortodoncia. El ortodoncista debe decidir, de acuerdo a las características biotipológicas del caso, qué solución es la más conveniente. El presente artículo describe el tratamiento de una paciente adolescente con una maloclusión de Clase II, división 1, en dentición permanente, braquifacial y que, además, presenta estrechez del maxilar superior. Atender en primer término el problema en el plano transversal es de vital importancia, pero asimismo, se debe planificar cómo corregir la Clase II y, si la distalización es el procedimiento indicado para tratarla, el verdadero reto es no perder anclaje. Se presenta un caso clínico tratado con aparato- logía fija y péndulum versión Pend-X (con tornillo de expansión transversal) y anclaje esqueletal(AU)

Aesthetic appearance, and especially marked protrusion, often encourage patients to request orthodontic treatment. The orthodontist must decide, according to biotypological characteristics of the case, which solution is the most convenient. This article describes the treatment of a teen patient with a Class II division 1 malocclusion, in permanent dentition, brachifacial and who also presents narrowness of upper jaw. Addressing the problem in the transverse plane first is of vital importance, but also, it must be planned how to correct Class II, and if distalization is the appropriate procedure to treat it, the real challenge is not to lose anchorage. It is presented a clinical case treated with fixed appliances and pendulum Pend-X version (with a transversal expansion screw) and skeletal anchorage(AU)

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.

Efficacy of vertical control by using mini-implant anchorage in maxillary posterior buccal area for Angle class Ⅱ extraction patients / 北京大学学报(医学版)

OBJECTIVE@#To investigate the efficacy of vertical control by using conventional mini-implant anchorage in maxillary posterior buccal area for Angle class Ⅱ extraction patients.@*METHODS@#Twenty-eight Angle class Ⅱ patients [9 males, 19 females, and age (22.6±2.8) years] were selected in this study. All of these patients were treated by using straight wire appliance with 4 premolars extraction and 2 mini-implant anchorage in maxillary posterior buccal area. In this study, the self-control method was used to measure and analyze the lateral radiographs taken before and after orthodontic treatment in each case, the main cephalometric analysis items were related to vertical changes. The digitized lateral radiographs were imported into Dolphin Imaging Software (version 11.5: Dolphin Imaging and Management Solutions, Chatsworth, California, USA), and marked points were traced. Each marked point was confirmed by two orthodontists. The same orthodontist performed measurement on the lateral radiographs over a period of time. All measurement items were required to be measured 3 times, and the average value was taken as the final measurement result.@*RESULTS@#Analysis of the cephalometric radiographs showed that, for vertical measurements after treatment, the differences of the following measurements were highly statistically significant (P < 0.001): SN-MP decreased by (1.40±1.45) degrees on average, FMA decreased by (1.58±1.32) degrees on average, the back-to-front height ratio (S-Go/N-Me) decreased by 1.42%±1.43% on average, Y-axis angle decreased by (1.03±0.99) degrees on average, face angle increases by (1.37±1.05) degree on average; The following measurements were statistically significant (P < 0.05): the average depression of the upper molars was (0.68±1.40) mm, and the average depression of the upper anterior teeth was (1.07±1.55) mm. The outcomes indicated that there was a certain degree of upper molar depression after the treatment, which produced a certain degree of counterclockwise rotation of the mandibular plane, resulting in a positive effect on the improvement of the profile.@*CONCLUSION@#The conventional micro-implant anchorage in maxillary posterior buccal area has a certain vertical control ability, and can give rise to a certain counterclockwise rotation of the mandible, which would improve the profile of Angle Class Ⅱ patients.

Estudos radiográficos do osso hioide e da coluna cervical nas maloclusões Classe I e Classe II/2ª Divisão de Angle / Radiographic studies of the hyoid bone and cervical spine in Angle Class I and Class II/2nd Division malocclusions

Introduction Interdisciplinary investigative study of the stomatognathic-cervical complex, necessary to understand the structure and biomechanics of the hyoid bone and cervical spine in Class I and II / 2nd Division participants. Objective To analyze the position of the hyoid bone and the curvature of the cervical spine on lateral radiographs of participants with Class I and II/2nd Division Angle malocclusion. Material and method We evaluated the position of the hyoid bone from its alignment with the corresponding cervical vertebra. The presentation of curvature of the cervical spine was evaluated from the fourth cervical vertebra. Result There was a statistically significant difference in the position of the hyoid bone (p=0.027) between the classes, which was located at C3 in Class I and further down, between C3 and C5, in Class II/2nd Division. The cervical spine showed alterations in both classes, with an increase, rectification, and inversion of the curvature with no statistical difference between them (p=0.533). Conclusion In this study, the hyoid bone showed different positions in the malocclusions studied, however, poor posture of the cervical spine was common in both classes.

Introdução Estudo interdisciplinar investigativo do complexo estomatognático-cervical, necessário para compreender a estrutura e a biomecânica do osso hioide e coluna cervical em participantes Classe I e II/2ª Divisão de Angle. Objetivo Analisar a posição do osso hioide e da curvatura da coluna cervical nas radiografias em perfil de participantes com má oclusão Classes I e II/2ª Divisão de Angle. Material e método A posição do osso hioide foi avaliada a partir de seu alinhamento com a vértebra cervical correspondente. A apresentação da curvatura da coluna cervical foi determinada a partir da proximidade com a quarta vértebra cervical. Resultado Houve diferença estatística significativa na posição do osso hioide (p=0,027) entre as classes, que ficou situado em C3 na Classe I e mais abaixo, entre C3 e C5, na Classe II/2ª Divisão. A coluna cervical apresentou alterações em ambas as classes sem diferença estatística entre as mesmas (p=0,533), com aumento, retificação e inversão da curvatura. Conclusão Neste estudo, o osso hioide apresentou posições distintas nas más oclusões estudadas, no entanto, a má postura da coluna cervical foi comum em ambas as classes.

Cambios en la vía aérea después de cirugía ortognática bimaxilar / Airway change after bimaxillary orthognathic surgery

RESUMEN: La cirugía ortognática se realiza en sujetos con algún tipo de alteración esqueletal. Los movimientos maxilo mandibulares tienen impacto en la vía aérea (VA) y este aspecto se debe incorporar en la planificación quirúrgica. El objetivo de esta investigación fue determinar los cambios generados en la VA después de realizada la cirugía ortognática. Se realizó un estudio piloto incluyendo 51 sujetos con deformidad facial de clase II y clase III; se incluyeron en base al estudio del ángulo ANB y el tipo de oclusión dentaria. Se realizaron estudios con tomografía de haz cónico identificando el volumen máximo en la vía área y las áreas mínimas y máximas; además se incluyó la posición del hueso hioide y la inclinación del plano mandibular para relacionar con la morfología de la VA; para definir significancia estadística se estableció un valor de p<0,05 incluyendo las pruebas T de student y T test. Los resultados indicaron que los sujetos clase II aumentaron significativamente el volumen y áreas máximas y mínimas de la VA; los sujetos de clase III esqueletal no presentaron diferencias significativas entre la etapa pre y post quirúrgica; el hueso hioides se presentó significativamente más anterior en ambos en casos de clase II y clase III. Es posible concluir que la VA mejora sustancialmente en sujetos con clase esqueletal facial tipo II y que se mantiene sin cambios en sujetos con clase facial tipo III.

SUMMARY: Orthognathic surgery is performed in subjects with some type of skeletal alteration. Maxillomandibular movements have an impact on the airway (AW) and this aspect must be included into surgical planning. The aim of this research is to determine the changes in the AW after orthognathic surgery. A pilot study was conducted including 51 subjects with class II and class III facial deformity; they were included using the ANB angle and the type of dental occlusion. Cone beam computed tomography were performed showing the maximum volume in the airway and the minimum and maximum areas; in addition, the position of the hyoid bone and the angle of the mandibular plane were included to relate it to the morphology of the AW; to define statistical significance, a value of p<0.05 was established, including the student's t-test and the t-test. The results showed that class II subjects significantly increased the volume and maximum and minimum areas of the AW; skeletal class III subjects did not presented significant differences between the pre- and post-surgical stage; the hyoid bone was in an anterior position in both class II and class III cases. It is possible to conclude that AW improves substantially in subjects with facial class II and remains unchanged in subjects with facial class III.

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