Tratamento compensatório da má oclusão de Classe III assimétrica com arcos multiloop: estabilidade após 10 anos de tratamento / Compensatory treatment of asymmetric Class III occlusion with multiloop archwires: stability after 10 years of treatment

Resumo Este relato de caso clínico apresenta o tratamento não cirúrgico de uma paciente de 17 anos e 4 meses de idade, com má oclusão de Classe III, subdivisão direita, assimetria facial, desvio do mento para a direita, perfil reto, mordida anterior de topo, com prognatismo mandibular e mordida cruzada posterior unilateral. Foi realizado um tratamento compensatório com arcos multiloop para nivelamento lateral e sagital do plano oclusal, uma vez que o tratamento ortodôntico-cirúrgico não foi aceito pela paciente devido aos custos e riscos envolvidos. Adequados trespasses vertical e horizontal foram alcançados, além da relação de Classe I, com uma melhora aceitável da assimetria facial que permaneceu estável após 10 anos do tratamento ortodôntico (AU)

Abstract This clinical case report presents the non-surgical treatment of a 17 years and 4 months old female patient, with right subdivision, Class III malocclusion, facial asymmetry, chin deviation to the right, straight profile, top anterior bite, with mandibular prognathism, and unilateral posterior crossbite. A compensatory treatment was performed with multiloop archwires for lateral and sagittal leveling of the occlusal plane, since the orthodontic-surgical treatment was not accepted by the patient due to the cost and risks involved. Adequate overjet and overjet were achieved, in addition to a Class I relationship, with an acceptable improvement in facial asymmetry that remained stable after 10 years of orthodontic treatment. (AU)

Reliability of a digital system for models measurements in BBO grading: A pilot study.

INTRODUCTION: Currently, no method is considered effective for the evaluation of digital models in the Certification Examination of the Brazilian Board of Orthodontics (BBO), considering the parameters of the currently used manual method. OBJECTIVE: Thus, the aim of this study is to verify the reliability of an evaluation method for digital models that could be used in the BBO exam, compared to the gold standard. METHODS: Measurements were performed by five previously calibrated examiners. Samples of ten sets of plaster models of the final phase of orthodontic treatment were measured using a manual method (Objective Grading System, OGS). These models were digitized using a 3D scanner and exported to Geomagic Qualify software, in which the measurements were made with the proposed digital method. These measurements were repeated using five models, after fifteen days. The intra-examiner performance with this method was analyzed with a paired t-test, whereas the inter-examiner analysis was carried out with analysis of variance and Tukey's test. To compare the manual and digital methods, a paired t-test and Pearson's correlation analysis were performed. RESULTS: A statistically significant difference was found. The results showed that, when compared to the manual method, the digital method was effective in measuring the OGS in four of the seven variables studied: Marginal Ridge, Overjet, Occlusal Contact, and Interproximal Contact. The variables Alignment, BL inclination, and Occlusal Relationship showed a great amount of dispersion in the findings. CONCLUSION: Further studies are needed to develop an adequate digital methodology that can be used for all OGS variables.

Reliability of a digital system for models measurements in BBO grading: A pilot study

ABSTRACT Introduction: Currently, no method is considered effective for the evaluation of digital models in the Certification Examination of the Brazilian Board of Orthodontics (BBO), considering the parameters of the currently used manual method. Objective: Thus, the aim of this study is to verify the reliability of an evaluation method for digital models that could be used in the BBO exam, compared to the gold standard. Methods: Measurements were performed by five previously calibrated examiners. Samples of ten sets of plaster models of the final phase of orthodontic treatment were measured using a manual method (Objective Grading System, OGS). These models were digitized using a 3D scanner and exported to Geomagic Qualify software, in which the measurements were made with the proposed digital method. These measurements were repeated using five models, after fifteen days. The intra-examiner performance with this method was analyzed with a paired t-test, whereas the inter-examiner analysis was carried out with analysis of variance and Tukey's test. To compare the manual and digital methods, a paired t-test and Pearson's correlation analysis were performed. Results: A statistically significant difference was found. The results showed that, when compared to the manual method, the digital method was effective in measuring the OGS in four of the seven variables studied: Marginal Ridge, Overjet, Occlusal Contact, and Interproximal Contact. The variables Alignment, BL inclination, and Occlusal Relationship showed a great amount of dispersion in the findings. Conclusion: Further studies are needed to develop an adequate digital methodology that can be used for all OGS variables.

RESUMO Introdução: Ainda não há um método considerado eficaz para análise dos modelos digitais no exame do Board Brasileiro de Ortodontia (BBO), considerando-se os parâmetros do método manual atual. Objetivo: Assim, o presente estudo objetiva verificar a confiabilidade de um método de avaliação em modelos digitais para o exame do BBO, comparando com o padrão-ouro. Métodos: As medições foram realizadas por 5 examinadores, previamente calibrados. A amostra de 10 pares de modelos de gesso da fase final do tratamento ortodôntico foi medida no método manual (Sistema Objetivo de Avaliação, SOA). Os modelos foram digitalizados por meio de um scanner 3D e exportados para o software Geomagic Qualify, onde foram feitas as medidas no método digital proposto. As medidas foram refeitas em 5 modelos após 15 dias. A análise intraexaminador desse método foi realizada por meio do teste t pareado; já a interexaminadores, feita com ANOVA e teste de Tukey, sendo encontrada diferença estatisticamente significativa. Para a comparação dos métodos manual e digital, foram utilizados o teste t pareado e a correlação de Pearson. Resultados: Uma diferença estatisticamente significativa foi encontrada. Os resultados mostraram que, comparada ao método manual, a metodologia digital mostrou-se eficaz para medição do SOA em quatro das sete variáveis estudadas: Margem interproximal, Sobressaliência, Contato oclusal e Contato interproximal. As variáveis Alinhamento, Inclinação V-L e Relação oclusal mostraram muita dispersão nos achados. Conclusão: Mais estudos são necessários para o desenvolvimento de uma metodologia digital adequada em todas as variáveis do SOA.

New highlights on effects of rapid palatal expansion on the skull base: a finite element analysis study.

OBJECTIVE: The objective of this study was to evaluate the effect of the rapid palatal expansion (RPE) on the pterygoid process (PP), spheno-occipital synchondrosis (SOS) and sella turcica (ST) in the skull of a patient with transversal maxillary collapse, and identify the distribution of mechanical stresses and displacement, by finite element analysis (FEA). METHODS: Cone-beam computed tomography (CBCT) was employed to examine the skull of a patient in this study. The patient was a 13-year-old boy, with Class II skeletal relationship due to transverse atresia and maxillary protrusion. The computer-aided design (CAD) geometry of skull was imported into the SimLab v. 13.1 software, to build the finite element mesh. For the simulation, a displacement of 1 mm, 3 mm and 5 mm in a transverse direction was defined at the midpalatal suture, thereby representing the RPE. For the analysis of results, maximum principal stress (MPS) and displacements were evaluated by identifying different nodes, which were represented by the points as per the areas of interest in the study. RESULTS: In MPS, the maximum tensile stress was found at point 2 (366.50 MPa) and point 3 (271.50 Mpa). The maximum compressive stress was found at point 8 (-5.84 Mpa). The higher displacements in the transversal plane and the lateral segment were located at point 1 (2.212 mm), point 2 (0.903 mm) and point 3 (0.238 mm). CONCLUSIONS: RPE has a direct effect on PP, SOS and ST in the Class II model skeletal relationship with a transversal maxillary collapse. PP supported a higher tensile stress and displacement.

Management of the Vertical Dimension in the Camouflage Treatment of an Adult Skeletal Class III Malocclusion.

Treating skeletal class III malocclusions is one of the biggest challenges in Orthodontics. Given the complexity of these cases, orthognathic surgery is often the best treatment option. However, many patients refuse this treatment due to its risks, morbidity, and costs involved. Alternatively, dental compensation can be planned for some of these skeletal problems. This case report presents a dentoalveolar compensation in the orthodontic treatment of a 20-year-old female patient with class III malocclusion, concave profile, anterior crossbite, mandibular prognathism, maxillary retrusion, and a vertical deficiency in the posterior region. Treatment planning involved a multiloop edgewise archwire (MEAW) associated with intermaxillary elastics with counterclockwise rotation of the occlusal plane in the posterior region of the maxilla aiming at obtaining an increased posterior vertical dimension. After 24 months of treatment, the severe anterior crossbite was corrected, and the skeletal class III relationship was camouflaged. At the end of the orthodontic treatment, it was possible to observe an improved facial profile, a nice smile, and a functional occlusion. The results remained stable at a three-year follow-up. The MEAW, associated with the use of elastics, seems to be an effective treatment option for class III camouflage with reduced posterior vertical dimension with no need for additional anchoring devices but requiring adequate bending of wires and patient compliance.

Tooth Loss Related to Root Perforation: Legal Approach in Endodontic Practice / Perdida Dentaria Relacionada con una Perforación Radicular: Una Visión Legal en la Práctica Endodóntica

Most of the techniques used in endodontic treatment are limited to the internal space to the tooth, avoiding reaching the periapical region. However, some accidents can happen, such as fracture of endodontic instruments, perforation, leakage of material, tooth fracture among others, depending on the complexityof each case. The aim of this study was to report a case involving a tooth loss caused by root perforation. In this case, the patient filed a lawsuit against the former professional who had performed endodontic treatment requiring compensation for moral and material damages. In conclusion, the practice endodontic the clarification of the risks is crucial, considering the particularities of each case. Thus, it is suggested that the verbal and written information should be offered to patients.

La mayoría de las técnicas usadas en el tratamiento de endodoncia son limitadas hacia la cavidad dentinaria pulpar coronal y el canal radicular, evitándose alcanzar la región periapical alveolar. Sin embargo, algunos accidentes pueden ocurrir, tales como: fracturas de instrumentos de endodoncia, perforaciones radiculares, extravasación del material de obturación y fracturas dentarias entre otros. Cada uno involucra una respectiva complejidad. El objetivo de esta publicación fue reportar un caso donde ocurrió la pérdida de un diente permanente causado por una perforación radicular. En este caso la paciente presentó una demanda contra el profesional quién realizó el tratamiento de endodoncia, solicitando una compensación por daños morales y materiales. Se concluye que en la práctica de endodoncia, la especificación de los riesgos es crucial, considerándose las particularidades de cada caso. Así, se sugiere que una buena información verbal y escrita deberá ser proporcionada al paciente.