Root resorption pattern in panoramic radiographs of pediatric patients with unilateral posterior crossbite: a cross-sectional and retrospective study / Patrón de reabsorción radicular en radiografías panorámicas de pacientes pediátricos con mordida cruzada posterior unilateral: estudio transversal y retrospectivo

SUMMARY: temporary mandibular molars in panoramic radiographs of pediatric patients with unilateral posterior crossbite (UPCB). This cross-sectional and retrospective study analyzed 114 orthopantomograms of patients between 6 - 9 years of age with unilateral posterior crossbite diagnosis. The first and second mandibular molars were analyzed. Their root resorption stage was typified, and the root lengths were measured; to later compare the data obtained depending on the malocclusion side. 86.4 % of molars showed a linear resorption pattern, and atypical resorption prevalence in patients with UPCB was 13.5 %. The total length average of the first molars on the side of the malocclusion was 8.20 mm, while the contralateral exhibited a mean of 9.29 mm. Lastly, the second molars had a mean length of 11.12 mm in crossbite side and 12.30 mm in the normal occlusion side. UPCB could affect physiological resorption by observing a resorption alteration in those mandibular molars located on the malocclusion side.

RESUMEN: El trabajo de este estudio se realizó en molares mandibulares temporales en radiografías panorámicas de pacientes pediátricos con mordida cruzada posterior unilateral (MCPU). Este estudio transversal y retrospectivo analizó 114 ortopantomografías de pacientes entre 6 - 9 años de edad con diagnóstico de mordida cruzada posterior unilateral. Se analizaron los primeros y segundos molares mandibulares. Se tipificó su estado de reabsorción radicular y se midió la longitud de las raíces; para luego comparar los datos obtenidos según el lado de la maloclusión. El 86,4 % de los molares mostró un patrón de reabsorción lineal y la prevalencia de reabsorción atípica en pacientes con MCPU fue del 13,5 %. El promedio de longitud total de los primeros molares del lado de la maloclusión fue de 8,20 mm, mientras que el contralateral exhibió una media de 9,29 mm. Por último, los segundos molares tenían una longitud media de 11,12 mm en el lado de mordida cruzada y de 12,30 mm en el lado de oclusión normal. La MCPU podría afectar la reabsorción fisiológica al observar una alteración de la reabsorción en aquellos molares mandibulares ubicados en el lado de la maloclusión.

Diámetro transversal del maxilar en pacientes con maloclusión del Policlínico Mario Escalona. 2019 / Maxillary transverse diameter in patients with malocclusion treated at Mario Escalona Polyclinic. 2019

Introducción: Las anomalías de crecimiento y desarrollo transversal del maxilar constituyen un diagnóstico frecuente en pacientes con maloclusiones. Objetivo: Describir el diámetro transversal del maxilar en pacientes con maloclusiones del Policlínico Mario Escalona, 2019. Material y método: Estudio descriptivo transversal. El universo estuvo formado por todos los pacientes (69), de 12 a 25 años con maloclusiones ingresados en el Servicio de Ortodoncia del policlínico Mario Escalona desde abril de 2018 a febrero de 2019. Se determinó el índice de Bogue y de Mayoral. Los resultados se presentaron en tablas. Resultados: Se encontró el diámetro de Bogue disminuido en el 65,0 por ciento de los pacientes donde se determinó. Todas las medidas de Mayoral analizadas presentaron como promedio valores por debajo de la norma en cada etapa de crecimiento y desarrollo; exceptuando las medidas de 4 a 4 en el Prepúber. En ambos sexos el índice de Mayoral en sus tres niveles o referencias se encontró como promedio por debajo de la norma. En el sexo femenino se detectaron las medias menores (33,7mm, 38,3mm, 44,4mm) respecto al masculino. Se diagnosticó Micrognatismo transversal en el 75,36 por ciento de los pacientes; 80,49 por ciento en las hembras y 67,86 por ciento en varones. Conclusiones: Se encontró una alta frecuencia de micrognatismo transversal. Se detectó discrepancias ligeras del índice de Mayoral según la clasificación sindrómica y la etapa de crecimiento y desarrollo, mientras que en cuanto al sexo se identificaron diferencias de consideración(AU)

Introduction: Growth anomalies and maxillary transverse diameter are frequent diagnoses in patients with malocclusions. Objective: To describe the maxillary transverse diameter in patients with malocclusions treated at Mario Escalona Polyclinic in 2019. Material and method: A cross-sectional descriptive study was conducted. The universe consisted of 69 patients aged 12-25 years who presented malocclusions and were admitted to the Orthodontics Service of Mario Escalona polyclinic from April 2018 to February 2019. Bogue´s index and the index of Mayoral were determined. The results were presented in tables. Results: The transverse diameter of Bogue decreased in 65.0 percent of the patients in whom it was determined. All measures established by Mayoral presented ​​lower average values than the norm at each stage of growth and development; except for measures 4/4 in pre-pubertal patients. In both sexes, the index of Mayoral in its three levels or references was found as an average value below the norm. Lower averages (33.7mm, 38.3mm, 44.4mm) were identified in the female sex with respect to the male sex. Transversal micrognathism was diagnosed in 75.36 percent of patients (80.49 percent females and 67.86 percent males). Conclusions: A high frequency of transversal micrognathism was found. Slight discrepancies of the index of Mayoral were identified according to the syndromic classification and the stages of growth and development while in terms of sex, significant differences were identified(AU)

Análisis de diferentes protocolos cefalométricos laterales. Parte II: consideraciones sobre diferentes aplicaciones / Analysis of different lateral cephalometric protocols. Part II: consideratios on different applications

El objetivo de esta segunda parte es relacionar el protocolo utilizado en el Ateneo Argentino de Odontología (A.A.O.) expuesto en la Parte I, con los cefalogramas laterales diseñados por los Dres. Arne Björk, Joseph Jarabak, James McNamara y Robert Ricketts y proponer las visiones complementarias en la búsqueda de un diagnóstico y un plan de tratamiento de mayor precisión. La aplicación de una secuencia lógica en el diagnóstico de una maloclusión permite establecer una categoría de análisis jerarquizada en función de los condicionantes y de las posibilidades de intervención terapéutica (AU)

The objective of this second part is to relate the protocol used in the Ateneo Argentino de Odontología (A.A.O.) exposed in Part I, with the lateral cephalograms designed by the Drs. Arne Bjork, Joseph Jarabak, James McNamara and Robert Ricketts and propose complementary visions in the search for a more accurate diagnosis and treatment plan. The application of a logical sequence in the diagnosis of malocclusion, allows to establish a category of hierarchical analysis according to the conditions and the possibilities of therapeutic intervention (AU)

Skeletal posterior crossbite in patient with mandibular asymmetry: an alternative solution

ABSTRACT Introduction: Skeletal posterior crossbite (SPCB) has a multifactorial etiology, as it may be caused by parafunctional habits, atypical position of the tongue, tooth losses and maxillary or mandibular transverse skeletal asymmetries. Skeletal involvement may lead to facial changes and an unfavorable aesthetic appearance. The treatment of SPCB diagnosed in an adult patient should be correctly approached after the identification of its etiologic factor. Surgically-assisted rapid maxillary expansion (SARME), one of the techniques used to correct SPCB in skeletally mature individuals, is an efficient and stable procedure for the correction of transverse discrepancies that may be performed in the office or in a hospital. Objective: This study discusses the results of asymmetrical SARME used to correct unilateral SPCB associated with transverse mandibular asymmetry. Conclusion: The treatment alternative used in the reported case was quite effective. At the end of the treatment, the patient presented adequate occlusion and facial aesthetics.

RESUMO Introdução: A mordida cruzada posterior esquelética (MCPE) apresenta etiologia multifatorial, podendo ser causada por hábitos parafuncionais, posição atípica da língua, perdas dentárias e assimetrias esqueléticas transversais da maxila ou da mandíbula. Alterações faciais podem estar presentes quando há envolvimento esquelético, levando a estética desfavorável. O tratamento da MCPE, quando diagnosticada no paciente adulto, requer abordagem correta, com identificação do fator etiológico. Entre as técnicas utilizadas para correção da MCPE em pacientes esqueleticamente maduros, cita-se, em especial, a Expansão Rápida de Maxila Assistida Cirurgicamente (ERMAC). Essa modalidade tem se mostrado bastante eficiente na correção dos problemas transversais, apresenta estabilidade e pode ser realizada em ambiente ambulatorial ou hospitalar. Objetivo: O objetivo do presente trabalho será discutir os resultados da ERMAC assimétrica para correção da MCPE unilateral associada a assimetria transversal da mandíbula. Conclusão: A alternativa de tratamento utilizada no caso relatado mostrou-se bastante eficiente. Ao fim do tratamento, o paciente apresentou adequada oclusão e boa estética facial.

Análisis de concordancia entre trazado cefalométrico manual y cefalométrico digital con programa Nemoceph / Analysis of concordance between manual cephalometric and digital cephalometric tracing with Nemoceph program

La importancia del análisis cefalométrico dentro del diagnóstico en ortodoncia ha ido incrementando a través de los años, por ello, el interés de comparar la confiabilidad de los sistemas digitales con el trazado manual convencional. Objetivo: Definir el grado de concordancia entre los resultados de trazado cefalométrico manual y con Nemoceph. Material y métodos: Se utilizaron ocho medidas lineales y angulares del análisis cefalométrico de Steiner. Se realizó un estudio transversal, correlacional, en el cual se analizaron 70 radiografías laterales de cráneo digitales. Los resultados se dividieron en dos grupos, trazado manual y trazado cefalométrico con Nemoceph, los cuales fueron evaluados con un índice de correlación intraclase. Conclusión: Se reportó un grado de correlación intraclase mayor a 0.75, estableciendo que el sistema digital exhibe la misma precisión del manual, con algunas ventajas convenientes a la época (AU)

The importance taken by the cephalometric analysis within the orthodontic diagnosis has been increasing over the years, for that reason the interest of comparing the reliability of the digital systems with the conventional manual tracing. Objective: To define the degree of concordance between the results of manual cephalometric tracing and with Nemoceph. Material and methods: Eight linear and angular measurements of Steiner's cephalometric analysis were used. A crosssectional, correlational study was conducted in which 70 digital skull lateral radiographs were analyzed. The results were divided into two groups; manual tracing and cephalometric tracing with Nemoceph, which were evaluated with an intraclass correlation index. Conclusion: a correlation degree greater than 0.75 was reported. Establishing that the digital system exhibits the same precision of the manual, with some advantages suited to the age (AU)

Retenciones múltiples. Reporte de un caso / Multiple retention. Case report

RESUMEN La retención dentaria es común encontrarla en la clínica de ortodoncia, los caninos maxilares son los de mayor solicitud de tratamiento por su importancia estética. Sin embargo, no es frecuente la retención de dientes temporales. Su etiología no está bien definida pero se considera de carácter multifactorial. Se presentó una paciente del sexo femenino de 12 años y medio de edad, con ausencia de 15 y 13, presencia de 53 y mesogresión del 16. Al examen radiográfico se observó retención de 55, 15 y 13, este último en transposición incompleta con el 12. Después de un profundo análisis se decidió exéresis del 55 y alineación al arco dentario de 15 y 13, mediante colocación de un dispositivo, con el empleo del sistema de cementado directo en el acto quirúrgico. Se estableció una oclusión funcional y estética aceptable, con particular cuidado de la integridad de los dientes vecinos y sus tejidos blandos. Las retenciones constituyen maloclusiones dentarias complejas y de difícil pronóstico y tratamiento, más aún cuando son múltiples. Se requiere de estudio y tratamiento multidisciplinario (AU).

ABSTRACT It is common to find teeth retention in Orthodontics clinic; maxillary canines, due to their esthetical importance, are the ones the patients ask to be treated more frequently. Nevertheless, temporary teeth retention is not frequent. Its etiology is not clear, but it is considered multifactorial. The authors present the case of a female patient, aged 12 years and a half, without 15 and 13 teeth, presence of 53 and mesogression of 16. At the radiographic examination, the retention of 55, 15 and 13 was found, and also the incomplete transposition of 13 and 12. After deeply analyzing the case, the orthodontists decided the removal of 55 and aligning 15 and 13 to dental arch, placing a device with the system of direct cementing at the moment of the surgery. It was established a functional occlusion and an acceptable esthetics, particularly caring for the neighboring teeth and their soft tissues. Retentions are complex dental malocclusions, of difficult prognosis and treatment, mainly when they are multiple. They require study and multidisciplinary treatment (AU).

La vertical verdadera al punto A´(blando), al Pg´(blando), al Labrale superior y al Labrale inferior en posición ideal asistida de la cabeza (PIAC) / The true vertical from point A´(soft), to Pg´ (soft), to superior Labrale and inferior Labrale in Ideal Assisted Head Position (PIAC)

El 81,3% de una encuesta realizada a 96 ortodoncistas y ortopedistas calificados y técnicos radiólogos consultados informan que ubican la cabeza del paciente en una posición ideal, subjetiva del profesional instruido que lo asiste, ya que muchas de sus fotografías y telerradiografías no son posiciones naturales de la cabeza genuinas. Se ha utilizado la vertical verdadera como parámetro para mediciones, todas angulares, para definir la disposición ánteroposterior del punto A´ (de construcción) para el cuerpo del labio superior, el punto Pg´para el mentón, el Labrale superior y el Labrale inferior para el bermellón de cada labio, con la finalidad de planificar correcciones ortopédicas, ortodóncicas u ortodóncicas-quirúrgicas de acuerdo a la anomalía detectada (AU)

Correlation between the cephalometric measurements and acoustic properties of /s/ sound in Turkish

Abstract Objectives To evaluate the acoustic properties of the /s/ sound in individuals with different occlusion types and to investigate relationships between these properties and cephalometric measurements. Methodology Sixty patients were divided into three groups based on malocclusion. Group 1 included 20 patients (mean age: 14.85±2.01 years) with Class I skeletal and dental relationships. Group 2 included 20 patients (mean age: 13.49±1.78 years) with Class II skeletal and dental relationships. Group 3 included 20 patients (mean age: 12.46±2.62 years) with Class III skeletal and dental relationships. Cephalometric tracings were obtained from cephalometric radiographs. All included patients were native speakers of Turkish. The /s/ sound was selected for center of gravity analysis. Correlations between cephalometric values and acoustic parameters were also investigated. Results The center of gravity of the /s/ sound had the lowest value in Group 2 (p<0.05). For the /s/ sound in Group 3, moderate positive correlations were found between center of gravity and Sella-Nasion to Gonion-Gnathion angle (p<0.05, r=0.444) Lower incisor to Nasion-B point (p<0.023, r=0.505), and Lower incisor to Nasion-B point angle (p<0.034; r=0.476). No correlation was found in other cephalometric measurements. Conclusions The /s/ sound was affected by malocclusion due to the changing place of articulation. Therefore, referral to an orthodontist for malocclusion treatment especially patients with class III in the early period is suggested for producing acoustically ideal sound.

Impact Produced by Oral Disorders on the Quality of Life of Brazilian Adolescents

Abstract Objective: To verify the impact produced by oral disorders on the quality of life of adolescents. Material and Methods: This is a cross-sectional study with a random sample of 680 individuals aged 15-19 years from public schools of Vitória, Brazil. The impact was assessed using the Oral Health Impact Profile (OHIP 14). Data were descriptively analyzed and then univariate analyses were performed with the Chi-square test and Fischer's exact test. The Mantel-Haenzsel test was used to evaluate the effects of the combined dimensions and Odds Ratio to evaluate the strength of the association. Logistic regression models were adjusted for each OHIP dimension Results: The impact on the quality of life was 26.2%, more frequently in the psychological discomfort dimension. The highest perception of impact was in female subjects, in physical pain (p=0.009, OR=1.998) and psychological discomfort dimensions (p=0.050, OR=1.495). In variable maternal education, children of mothers with only complete elementary education are 1.6 times more likely to have an impact on the quality of life in the psychological discomfort dimension (OR=1.6 95% CI=1.037, 2.474). Halitosis was the independent variable with the highest frequency of impact in the combined Mantel-Haenszel test, and OR was found to be 2.81 (95% CI=1.670, 3.366) for individuals who perceive halitosis. In the logistic regression analysis in the seven OHIP dimensions, the results confirm that the variables that explain impact are gender (p=0.035, OR = 1.502) and halitosis (p<0.001, OR=2.365) Conclusion: Oral health problems significantly affect the quality of life of adolescents and that subjective indicators are important tools to determine the need for treatment, improving oral health and quality of life of this population.

Orthodontic treatment time: can it be shortened?

Abstract Introduction: In the literature, no consensus has been reached about orthodontic treatment time. Similarly, the determining factors of the latter have not yet been completely elucidated. Objective: The aim of the present article was to deepen the discussion on the major factors influencing orthodontic treatment time, as well as to present some strategies that have proven effective in controlling and shortening it. Method: Based on evidences found in the literature, the method focussed in providing the basis for clinical decision-making. Conclusions: Treatment time varies according to the type of malocclusion and treatment options. Orthodontist's influence, patient's characteristics and compliance are all decisive in determining treatment time, while the effects provided by orthodontic appliances and methods used to speed tooth movement up seem little effective.

Resumo Introdução: não existe consenso na literatura sobre a duração do tratamento ortodôntico, e os fatores relacionados com a sua determinação ainda não estão totalmente elucidados. Objetivo: o objetivo do presente artigo foi aprofundar a discussão dos principais fatores que podem influenciar na duração do tratamento ortodôntico, bem como apresentar algumas estratégias que têm se mostrado eficientes para controlá-la e reduzi-la. Método: a partir das evidências apresentadas na literatura, fundamentar as decisões clínicas. Conclusões: o tempo de tratamento varia de acordo com o tipo de má oclusão e com as opções de tratamento. A influência do ortodontista, as características do paciente e sua colaboração são fatores decisivos na definição do tempo de tratamento, enquanto os efeitos dos dispositivos ortodônticos e os métodos de aceleração do movimento dentário parecem ser pouco efetivos.

Facial asymmetry: virtual planning to optimize treatment predictability and aesthetic results

Abstract Facial asymmetry is a condition that compromises function and social interactions and, consequently, the quality of life. Orthodontic-surgical treatment may be indicated to achieve a stable occlusion and significant improvement in facial aesthetics. The virtual planning of the maxillary, mandibular and chin movements can be done prior to surgery. These movements can be successfully performed with the use of prototyped guides obtained from virtual planning. The aim of this article is to show the state of the art of treatments of facial asymmetries, and emphasize how important is the multi-disciplinary approach to achieve predictable aesthetic and functionally stable results in a patient with facial asymmetry and chin protrusion.

Resumo A assimetria facial é uma condição capaz de comprometer a função oclusal e as interações sociais e, consequentemente, a qualidade de vida dos indivíduos. Nessas condições, para se obter oclusão estável e melhora significativa na estética facial, o tratamento ortodôntico-cirúrgico pode estar indicado. A simulação virtual da cirurgia permite planejar de forma adequada, e antecipada, os movimentos cirúrgicos a serem efetuados na maxila, mandíbula e mento. Esses movimentos são, então, realizados com sucesso graças ao uso de guias prototipados obtidos a partir do planejamento virtual. Assim, os objetivos do presente artigo consistem em relatar o estado da arte no planejamento virtual do tratamento de um paciente com assimetria facial e protrusão do mento, e enfatizar a importância da abordagem multidisciplinar para se atingir resultados estéticos previsíveis e funcionalmente estáveis.

Mini-implant selection protocol applied to MARPE

Abstract Introduction: Rapid maxillary expansion (RME) is the therapy of choice to correct skeletal transverse dimension in children and adolescents, associating orthopedic and dental effects. In an attempt to prevent the undesirable dentoalveolar effects and optimize the potential of skeletal expansion in individuals in advanced stages of skeletal maturation, the miniscrew-assisted rapid palatal expander (MARPE) was proposed by Lee et al. in 2010. Objective: This paper presents a systematized protocol for selection of miniscrews indicated for MARPE, by the evaluation of cone-beam computed tomographies (CBCT). Variables related with the bone and soft tissue thicknesses at the palatal regions of interest, as well as in relation to the fixation rings of miniscrews of the palatal expander are analyzed and discussed to provide better performance in the clinical practice.

Resumo Introdução: a expansão rápida da maxila (ERM) é a terapia de escolha para a correção da dimensão transversa esquelética em crianças e adolescentes, associando-se efeitos ortopédicos e dentários. Com a finalidade de prevenir os efeitos dentoalveolares indesejáveis e otimizar o potencial de expansão esquelética em indivíduos com estágios avançados de maturação esquelética, a técnica de expansão rápida da maxila assistida por mini-implantes (MARPE) foi proposta por Lee e colaboradores em 2010. Objetivo: o presente estudo apresenta um protocolo sistematizado para seleção de mini-implantes indicados para a MARPE, mediante avaliação de imagens de tomografia computadorizada de feixe cônico (TCFC). Variáveis relacionadas à espessura de tecido ósseo e tecido mole nas regiões de interesse do palato, bem como em relação ao anel de fixação dos mini-implantes do parafuso expansor, são analisadas e discutidas para proporcionar melhor desempenho na prática clínica.

Relación entre el patrón esqueletal y la posición cráneo-cervical / Relationship between the skeletal pattern and the cranial-cervical position

Introducción: Los problemas posturales se inician, en la mayoría de los casos, en la infancia, por lo tanto en período de crecimiento una actitud postural alterada compromete el equilibrio cefálico y la posición de la mandíbula pudiendo originar malocluciones. Objetivo: Analizar si existe relación entre el ángulo cráneo-cervical y el patrón esqueletal en una población infantil. Material y métodos: Se evaluaron 70 pacientes con telerradiografía de cráneo de perfil con exámenes cefalométrico de Ricketts con patrón esqueletal de clase I, II y III (Campo II relación cráneo-mandibular, factor 7 convexidad) y el cefalograma de Rocabado, utilizando el ángulo cráneo-vertebral. Resultado: Tanto el sexo como el patrón esqueletal son significativos, su interacción no lo es. A su vez, la edad no resulta significativa. Conclusión: En el presente estudio se encontró que existe relación significativa entre el ángulo cráneo-cervical y el patrón esqueletal (AU)

Introduction: Postural problems begin in most cases, in childhood, therefore during growth an altered postural attitude compromises the cephalic balance and jaw position causing posible malocclucion. Objective: It is to present the correlation between the skull and cervical angle skeletal pattern in a child population. Material and methods: 70 patients were evaluated with teleradiography cephalometric profile tests Ricketts skeletal pattern with class I, II and III (Field II craniomandibular relationship, Factor 7 convexity) and cephalogram Rocabado, using the craniovertebral angle. Result: Both sex and skeletal pattern are significant and their interaction is not. In turn, age is not significant. Conclusion: In the present study it was found that there is a statistically significant relationship between the cranial-cervical angle, and the skeletal pattern (AU)

Virtual orthodontic setup in orthodontic camouflage planning for skeletal Class III malocclusion

ABSTRACT The purpose of this paper was to emphasize the importance of the orthodontic setup in treatment planning for skeletal Class III malocclusion correction in an adult patient with moderate lower anterior crowding and anterior crossbite associated with two supernumerary lower incisors.

RESUMO O objetivo desse artigo é enfatizar a importância do setup ortodôntico no planejamento do tratamento da má oclusão de Classe III esquelética de uma paciente adulta com apinhamento anteroinferior moderado e mordida cruzada anterior associada à presença de dois incisivos inferiores supranumerários.

Three-dimensional evaluation of mandibular anterior dental crowding in digital dental casts

ABSTRACT Introduction: Digital dental models provide a more accurate and comprehensive assessment of orthodontic cases. Although this technique is quite promising, there are few three-dimensional measurements methods described in the literature. Objective: The aim of this study was to propose a method for assessing the degree of mandibular anterior dental crowding in the three planes of space, using digital dental models. Methods: Thirty dental casts were selected and scanned by Maestro 3D Dental Scanner and imported by Geomagic Qualify 2013 software. The degree of crowding was calculated by two examiners, based on the Little's Irregularity Index, by means of the definition of axial, coronal and sagittal planes for each model. Intraexaminer analysis was performed with Dahlberg's Formula (DF) and Intraclass Correlation Coefficients (ICC), and interexaminer analysis was performed with ICC and paired t-test. Results: The ICC showed an excellent agreement (p < 0.05) for all measurements, except for the intraexaminer and interexaminer in the Z-axis, in which it was found a moderate agreement. The DF showed a satisfactory accuracy with all measurements showing less than 1 mm difference. The paired t-test showed statistical difference between the examiners in two measurements, although it was clinical irrelevant. Conclusion: When comparing the three planes of space, the Z-axis showed the greatest variation in landmarks placement; however, overall, the present method seems precise and reproducible.

RESUMO Introdução: os modelos digitais fornecem uma avaliação mais precisa e abrangente dos casos ortodônticos. Embora essa técnica seja bastante promissora, existem poucos métodos de medição tridimensional descritos na literatura. Objetivo: o objetivo do presente estudo foi propor um método para avaliar o grau de apinhamento dentário anteroinferior, nos três planos do espaço, usando modelos digitais. Métodos: trinta modelos de gesso foram selecionados, escaneados pelo scanner Maestro Dental 3D e importados para o software Geomagic Qualify 2013. Dois examinadores calcularam o grau de apinhamento, com base no Índice de Irregularidade de Little, mediante a definição dos planos axial, coronal e sagital para cada modelo. A análise intraexaminador foi realizada por meio da fórmula de Dahlberg (FD) e do Coeficiente de Correlação Intraclasse (ICC), enquanto a análise interexaminadores foi realizada com o ICC e o teste t pareado. Resultados: o ICC mostrou um excelente grau de concordância (p< 0,05) para todas as medições, exceto para as avaliações intraexaminador e interexaminadores no eixo Z, onde foi encontrado um grau moderado. A FD mostrou uma precisão satisfatória, com todas as medidas apresentando diferença menor que 1 mm. O teste t pareado mostrou diferenças estatisticamente significativas entre os examinadores em duas medidas, apesar de terem sido clinicamente irrelevantes. Conclusão: ao se comparar os três planos do espaço, o eixo Z mostrou maior variação na marcação de pontos; no entanto, em geral, o presente método parece ser preciso e reprodutível.

Impact of rapid maxillary expansion on nasomaxillary complex volume in mouth-breathers

ABSTRACT Objective: To assess the volumetric changes that occur in the nasomaxillary complex of mouth-breathing patients with transverse maxillary deficiency subjected to rapid maxillary expansion (RME). Methods: This was a controlled, prospective intervention study involving 38 mouth-breathing patients presenting with transverse maxillary deficiency, regardless of malocclusion type or race. Twenty-three of them comprised the experimental group, which was composed of 11 (47.8%) boys, and 12 (52.2%) girls, with a mean age of 9.6 years, ranging from 6.4 to 14.2 years and standard deviation of 2.3 years; and 15 of them comprised the control group, composed of 9 (60%) boys and 6 (40%) girls with an mean age of 10.5 years, ranging from 8.0 to 13.6 years, and standard deviation of 1.9 years. All patients were scanned (CT) according to a standard protocol: Initial CT (T1), and CT three months thereafter (T2), and the patients in the experimental group were treated with RME using a Hyrax expander for the correction of maxillary deficiency during the T1-T2 interval. The CT scans were manipulated using Dolphin® Imaging version 11.7 software for total and partial volumetric assessment of the nasomaxillary complex. Results: The results revealed that in the experimental group there was a significant increase in the size of the structures of interest compared to the control group, both in general aspect and in specific regions. Conclusions: Rapid maxillary expansion (RME) provided a significant expansion in all the structures of the nasomaxillary complex (nasal cavity, oropharynx, right and left maxillary sinuses).

RESUMO Objetivo: avaliar as alterações volumétricas do complexo nasomaxilar em pacientes respiradores bucais com deficiência transversal da maxila tratados com expansão rápida da maxila (ERM). Métodos: foram selecionados 38 pacientes respiradores bucais, independentemente da má oclusão ou raça, portadores de constrição maxilar, e realizou-se um estudo de intervenção, prospectivo, controlado. Para o grupo experimental, foram selecionados 23 pacientes, sendo 11 (47,8%) meninos e 12 (52,2%) meninas, com média de idade de 9,6 anos (variando de 6,4 a 14,2 anos) e desvio-padrão de 2,3 anos; e 15 pacientes para o grupo controle, sendo 9 (60%) meninos e 6 (40%) meninas, com média de idade de 10,5 anos (variando de 8,0 a 13,6 anos) e desvio-padrão de 1,9 anos. Todos os pacientes realizaram exames de tomografia computadorizada (TC), de acordo com protocolo padronizado: TC inicial (T1) e TC após três meses do período de contenção (T2). Os pacientes do grupo experimental foram tratados com expansão rápida da maxila usando um expansor Hyrax para a correção da deficiência transversal durante o intervalo T1-T2. As imagens tomográficas para avaliação volumétrica total e parcial do complexo nasomaxilar foram manipuladas no programa Dolphin ® versão 11.7. Resultados: os resultados revelaram que no grupo experimental houve um aumento significativo no tamanho das estruturas de interesse em comparação com o grupo controle, tanto no geral quanto nas regiões específicas. Conclusões: a expansão rápida da maxila (ERM) promoveu uma expansão significativa de todas as estruturas do complexo nasomaxilar (cavidade nasal, orofaringe, seios maxilares direito e esquerdo).

Diagnóstico cefalométrico de la relación sagital intermaxilar, ángulo ANB y pruebas alternativas: artículo de revisión / Cephalometric diagnosis of intermaxillary sagittal relationship, ANB angle and alternative tests: a review article

La manifestación clínica de la relación sagital entre los maxilares superior e inferior ha sido utilizada de forma fiable y válida, hasta la actualidad. El objetivo de este trabajo ha sido realizar una revisión histórica y análisis del estado arte del Ángulo ANB como prueba diagnóstica gold estándar de la relación sagital intermaxilar necesaria para decidir el tipo de tratamiento ortodóncico u ortopédico a aplicar, así como un estudio de los diferentes factores que pueden afectar la validez de este test de diagnóstico, además de hacer una revisión de pruebas diagnósticas alternativas propuestas por diferentes autores, establecer su funcionalidad en la toma de decisiones clínicas terapéuticas. Se realiza una revisión de las diferentes metodologías estadísticas como estudios de correlación y uso del análisis deCaracterística Operativa Relativa (ROC), que observa la sensibilidad y la especificidad de la prueba y es un indicador de su habilidad diagnóstica. Esta revisión sistemática se la ha realizado en base a información bibliográfica (1952-2015) a través de Biblioteca virtual, en Postgrado de Ortodoncia de la Facultad de Odontología de la Universidad de Buenos Aires.

The clinical manifestation of anteroposterior relationship between the upper and lower jaws has been used in a reliable and valid untiltoday. The aim of this study was to conduct a historical review and state of the art analysis of ANB angle as a diagnostic gold standardsagittal intermaxillary relationship needed to decide the type of orthodontic or orthopedic treatment to apply, and a study of the differentfactors that can affect the validity of the diagnostic test, in addition to a review of alternative diagnostic tests proposed by differentauthors, establish their functionality in making therapeutic clinical decisions. Reviews of the different statistical methodologies ascorrelation studies and analyzes of Relative Operating Characteristic (ROC) were performed, noting the sensitivity and specificity of thetest, being an indicator of its diagnostic utility. This systematic review has made based on bibliographic information (1952-2015) through Virtual Library in Orthodontics Graduate School of Dentistry at the University of Buenos Aires.

Subjective facial analysis and its correlation with dental relationships

ABSTRACT INTRODUCTION: Subjective facial analysis is a diagnostic method that provides morphological analysis of the face. Thus, the aim of the present study was to compare the facial and dental diagnoses and investigate their relationship. METHODS: This sample consisted of 151 children (7 to 13 years old), without previous orthodontic treatment, analyzed by an orthodontist. Standardized extraoral and intraoral photographs were taken for the subjective facial classification according to Facial Pattern classification and occlusal analyses. It has been researched the occurrence of different Facial Patterns, the relationship between Facial Pattern classification in frontal and profile views, the relationship between Facial Patterns and Angle classification, and between anterior open bite and Long Face Pattern. RESULTS: Facial Pattern I was verified in 64.24% of the children, Pattern II in 21.29%, Pattern III in 6.62%, Long Face Pattern in 5.96% and Short Face Pattern in 1.99%. A substantial strength of agreement of approximately 84% between frontal and profile classification of Facial Pattern was observed (Kappa = 0.69). Agreement between the Angle classification and the Facial Pattern was seen in approximately 63% of the cases (Kappa = 0.27). Long Face Pattern did not present more open bite prevalence. CONCLUSION: Facial Patterns I and II were the most prevalent in children and the less prevalent was the Short Face Pattern. A significant concordance was observed between profile and frontal subjective facial analysis. There was slight concordance between the Facial Pattern and the sagittal dental relationships. The anterior open bite (AOB) was not significantly prevalent in any Facial Pattern.

RESUMO INTRODUÇÃO: a análise facial subjetiva é um método diagnóstico que privilegia a avaliação morfológica da face; assim, o principal objetivo do presente trabalho foi comparar os diagnósticos faciais e dentários e investigar a correlação entre eles. MÉTODOS: a amostra consistiu de 151 crianças (7 a 13 anos de idade), sem nenhum tratamento ortodôntico prévio, analisadas por um ortodontista. Foram realizadas fotografias padronizadas extrabucais e intrabucais, para a classificação subjetiva dos Padrões Faciais e das relações dentárias segundo a classificação de Angle. Investigou-se a ocorrência de diferentes tipos de Padrões Faciais, em vistas frontal e de perfil; a relação entre os Padrões Faciais e as relações dentárias de Classe e, também, entre a má oclusão de mordida aberta anterior e o Padrão Face Longa. RESULTADOS: o Padrão Facial I (PF I) esteve presente em 64,24% das crianças; o PF II, em 21,29%; o PF III, em 6,62%; o PF Face Longa, em 5,96% e o PF Face Curta, em 1,99%. Observou-se concordância substancial entre a avaliação do PF na vista frontal e na de perfil, igual a 84% (Kappa = 0,69). Houve concordância entre a avaliação da relação dentária de Classe e do PF em 63% da amostra (Kappa = 0,27). O PF Face Longa não demonstrou maior prevalência da má oclusão de mordida aberta. CONCLUSÃO: os Padrões Faciais I e II foram os mais prevalentes em crianças, enquanto o menos prevalente foi o Padrão Face Curta. Verificou-se concordância significativa entre as análises faciais frontal e de perfil. Existe uma ligeira concordância entre o Padrão Facial e a relação sagital dentária. A mordida aberta anterior não se apresentou mais prevalente em nenhum tipo de Padrão Facial.

Agenesis of mandibular second premolar in patient with dental bimaxillary protrusion

ABSTRACT The present study reports the treatment carried out in a patient with mandibular second premolar agenesis associated with early loss of a deciduous second molar, deep overbite, severe overjet and dentoalveolar bimaxillary protrusion, which led to lip incompetence and a convex facial profile. The main objectives of this treatment were: to eliminate the spaces in mandibular arch, correct overbite, as well as eliminate bimaxillary protrusion and lip incompetence, thus leading to a balanced profile. The case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as part of the requirements to obtain the title of BBO diplomate.

RESUMO O presente caso clínico relata o tratamento de uma paciente com agenesia de segundo pré-molar inferior associada à perda precoce do segundo molar decíduo, sobremordida profunda, sobressaliência exagerada e biprotrusão dentoalveolar, que causavam incompetência labial e perfil facial convexo. Os objetivos do tratamento foram eliminar os espaços presentes na arcada inferior, corrigir a sobremordida, eliminar a biprotrusão e a incompetência labial, harmonizando o perfil. Esse caso foi apresentado ao Board Brasileiro de Ortodontia e Ortopedia Facial (BBO) como parte dos requisitos para obtenção do título de Diplomado pelo BBO.

Non-surgical treatment of transverse deficiency in adults using Microimplant-assisted Rapid Palatal Expansion (MARPE)

ABSTRACT Introduction: Maxillary transverse deficiency is a highly prevalent malocclusion present in all age groups, from primary to permanent dentition. If not treated on time, it can aggravate and evolve to a more complex malocclusion, hindering facial growth and development. Aside from the occlusal consequences, the deficiency can bring about serious respiratory problems as well, due to the consequent nasal constriction usually associated. In growing patients, this condition can be easily handled with a conventional rapid palatal expansion. However, mature patients are frequently subjected to a more invasive procedure, the surgically-assisted rapid palatal expansion (SARPE). More recently, researches have demonstrated that it is possible to expand the maxilla in grown patients without performing osteotomies, but using microimplants anchorage instead. This novel technique is called microimplant-assisted rapid palatal expansion (MARPE). Objective: The aim of the present article was to demonstrate and discuss a MARPE technique developed by Dr. Won Moon and colleagues at University of California - Los Angeles (UCLA). Methods: All laboratory and clinical steps needed for its correct execution are thoroughly described. For better comprehension, a mature patient case is reported, detailing all the treatment progress and results obtained. Conclusion: It was concluded that the demonstrated technique could be an interesting alternative to SARPE in the majority of non-growing patients with maxillary transverse deficiency. The present patient showed important occlusal and respiratory benefits following the procedure, without requiring any surgical intervention.

RESUMO Introdução: a deficiência transversa da maxila é uma má oclusão com alta prevalência em todas as faixas etárias, da dentição decídua à permanente. Se não for corrigida, pode agravar-se com o passar do tempo, prejudicando o crescimento e desenvolvimento facial. Além dos prejuízos oclusais, essa deficiência pode trazer problemas respiratórios também severos, devido à consequente constrição da cavidade nasal. Em pacientes em crescimento, a sua resolução é relativamente simples, por meio da expansão rápida convencional da maxila. Porém, os pacientes já maduros geralmente são encaminhados para um procedimento mais invasivo, a expansão rápida de maxila assistida cirurgicamente (SARPE). Mais recentemente, pesquisadores têm demonstrado que é possível executar a expansão palatal esquelética em pacientes adultos sem auxílio de osteotomias, mas sim com auxílio de mini-implantes. Essa técnica é denominada Microimplant-Assisted Rapid Palatal Expansion, ou MARPE. Objetivo: o objetivo do presente artigo é demonstrar e discutir uma das técnicas disponíveis de MARPE, desenvolvida por Won Moon e colaboradores, na University of California, Los Angeles (UCLA). Métodos: a técnica encontra-se detalhadamente descrita, com as etapas laboratoriais e clínicas que devem ser seguidas para sua correta execução. Para descrevê-la, é apresentado o caso clínico de uma paciente adulta, detalhando toda a sequência do tratamento e os resultados obtidos. Conclusão: a técnica apresentada pode ser uma alternativa não invasiva à SARPE na resolução da deficiência transversa de maxila, podendo ser empregada na maioria dos pacientes com crescimento facial finalizado. A paciente apresentada demonstrou benefícios significativos nos aspectos oclusal e respiratório, sem a necessidade de intervenção cirúrgica.