Facial profile changes due to bone cement graft to manage the hyperactive muscles of the gingival smile.

OBJECTIVE: To evaluate facial profile changes promoted by polymethyl methacrylate (PMMA) cement graft to reduce excessive gingival display due to hyperactivity of the elevator muscles of the upper lip during smiling. METHODS: Eleven patients (all females, age range: 20 to 43 years) presenting gingival smile that were treated with PMMA cement grafts in a private clinic were selected for this retrospective study. Three angular and ten linear cephalometric facial profile measurements were performed preoperatively (baseline, T1) and at least 6 months postoperatively (T2). Differences between T1 and T2 were verified by Wilcoxon test, and the correlation between the thickness of the graft and facial profile changes was statistically evaluated by Spearman's Coefficient test. The significance level was set at p< 0.05. RESULTS: The nasolabial angle (p= 0.03) and the labial component of the nasolabial angle showed statistically significant differences (p= 0.04), with higher values in T2. No correlations were found between the graft thickness and the statistically significant facial profile changes (p> 0.05). CONCLUSIONS: The PMMA bone cement graft projected the upper lip forward, thereby increasing the nasolabial angle without affecting the nasal component. No correlations between the graft thickness and the facial profile changes were detected.

Comparison of Dimensions of the Nasopharynx and Oropharynx Using Different Anatomical References: Is There Equivalence?

PURPOSE: To evaluate the equivalence of the volumes obtained using different anatomic references to measure the nasopharynx and oropharynx on cone-beam computed tomography (CBCT) scans. We hypothesized that no variations would be found in the nasopharynx and oropharynx dimensions when measured using different measurement methods. MATERIALS AND METHODS: A total of 40 CBCT scans of patients with skeletal Class I (age range, 20 to 50 years) were measured independently by 2 of us. The nasopharynx and oropharynx subregions were volumetrically measured using the adopted limits of 5 different measurement methods (3 for the nasopharynx and 2 for the oropharynx) and InVivoDental software, version 5.4 (Anatomage, San Jose, CA). The minimum area and the minimum area of localization were also evaluated. The intra- and interexaminer concordance for the measurements from the different methods were verified using the interclass correlation coefficient (ICC). The analysis of variance for repeated measures was used to compare the measurements from the 3 nasopharynx methods. The paired t test was used to compare the measurements from the 2 oropharynx methods. The statistical tests were performed at the 5% significance level using SPSS software, version 22.0 (IBM Corp, Armonk, NY). RESULTS: The intra- and interexaminer ICC values were greater than 0.8. We found a statistically significant difference in the volume measurements among the 3 nasopharynx methods (P = .001). However, no differences were found in the minimum area or minimum area of localization comparisons. Statistically significant differences were also observed for the volume, minimum area, and minimum area of localization between the 2 oropharynx methods (P = .001). CONCLUSIONS: Studies that have used different methods of measurement should not be directly compared. The different measurement methods used for nasopharynx and oropharynx evaluations should not be compared.

Maxillary canine morphology: comparative and descriptive analysis from periapical radiographs and cone beam computed tomography.

The anatomical characteristics of permanent maxillary canines were evaluated through visual examination, periapical radiography, and cone beam computed tomography (CBCT), and measurements obtained from the images and directly on the teeth were compared. Fifty extracted human maxillary canines were classified according to the side of the mouth. The direction of root curvature and location of the apical foramen were also verified. Periapical radiographs and CBCTs of the specimens were obtained. The number of root canals was verified. Tooth length and the mesiodistal and buccopalatal widths of the root were measured directly on the specimens as well as on the radiographs and CBCTs. Data were analyzed by chi-square testing and analysis of variance (α = 0.05). All teeth-26 (52%) from the right side of the dental arch and 24 (48%) from the left-had only 1 main canal each. The apical foramen was located exactly in the root apex in 34 teeth (68%). Root curvature toward the distal side was observed in the apical third in 23 teeth (46%). There were no statistically significant differences between the canines' arch side and either the foramen location (P = 0.104) or the root curvature (P = 0.215). No statistically significant differences were found in measurements of tooth length (P = 0.669), mesiodistal root width (P = 0.517), or buccopalatal root width (P = 0.672) obtained from specimens and images. Both CBCTs and periapical radiographs were reliable for determining the tooth length, mesiodistal root width, and buccopalatal root width of maxillary canines and produced statistically similar measurements.

Effect of Genioplasty on the Pharyngeal Airway Space Following Maxillomandibular Advancement Surgery.

PURPOSE: To evaluate the effect of genioplasty on the size of the pharyngeal airway space (PAS) in a sample of patients without obstructive sleep apnea syndrome (OSAS) undergoing maxillomandibular advancement (MMA) surgery. MATERIALS AND METHODS: Lateral cephalometric radiographs of 52 patients who underwent orthognathic surgery for MMA were obtained before (T1) and after (T2) surgery. The radiographs were digitized and the anteroposterior dimensions of the PAS were measured at the nasopharynx, oropharynx, and hypopharynx levels. The sample was divided into 2 groups: MMA with genioplasty (n = 27; average age, 30.81 yr) and without genioplasty (n = 25; average age, 37.64 yr). Comparisons were made between T1 and T2 in patients with and without genioplasty. Horizontal and vertical changes of the maxilla, mandible, and chin were correlated to changes in the PAS. RESULTS: MMA resulted in an increased anteroposterior PAS at the 3 levels analyzed (P < .05), except in the hypopharynx, in cases without genioplasty (P = .141). When the groups with and without genioplasty were compared, there were no significant differences (P > .05) in the PAS. There was a statistically relevant correlation between horizontal mandibular change and the oropharynx (r = 0.484 and r = 0.509, respectively) and between vertical chin change and the hypopharynx (r = 0.434 and r = 0.455, respectively) for groups with and without genioplasty. There was a statistically relevant correlation between horizontal chin change and the hypopharynx (r = 0.586) for surgeries without genioplasty. CONCLUSION: Considering the limitations inherent to retrospective study designs, the results suggested that MMA surgery, with and without advancement genioplasty, can promote immediate gains to the PAS. A larger gain was possible in the hypopharynx for MMA with genioplasty. MMA without genioplasty could represent a greater gain in the nasopharynx and oropharynx. Further studies should evaluate functional parameters in patients with OSAS to measure the possible benefits of this increase in the PAS.

Radiographic evaluation of orthodontic treatment by means of four different cephalometric superimposition methods.

INTRODUCTION: Despite discussion on the merit of various cephalometric superimposition methods, there remains a need to assess which one can be used in daily practice with reasonably accuracy and less working time. OBJECTIVE: The aim of this study was to investigate four methods of cephalometric superimposition by means of assessing the longitudinal changes in craniofacial morphology caused by growth and response of adolescents with Class I malocclusion to orthodontic treatment involving first premolar extraction. METHODS: Pretreatment (T1) and post-treatment (T2) standardized lateral cephalometric radiographs of 31 adolescents (20 females and 11 males), with Angle Class I malocclusion and indication of premolar extraction, participated in this study. Radiographs were digitized, traced and had structures identified by means of a cephalometric software. Four superimposition methods were used: Björk structural method, Steiner/Tweed SN line, Ricketts N-Ba line at N-point and Ricketts N-Ba line at CC-point. Positional changes were quantified by horizontal and vertical linear changes in the following cephalometric landmarks: anterior/posterior nasal spine (ANS and PNS), gnathion (Gn), Gonion (Go), Pogonion (Pog), A-point and B-point. Differences between T1 and T2 in horizontal and vertical positional changes for all superimposition methods were assessed by one-way analysis of variance (ANOVA) and Bonferroni correction (p < 0.05). RESULTS: There were no statistically significant differences among the cephalometric superimposition methods or when patients' sex was considered. CONCLUSION: Björk structural method, Steiner/Tweed SN line, Ricketts N-Ba line at N-point and Ricketts N-Ba line at CC-point methods were reliable and presented similar precision when the overall facial changes due to active growth and/or orthodontic treatment were examined.

Radiographic evaluation of orthodontic treatment by means of four different cephalometric superimposition methods

INTRODUCTION: Despite discussion on the merit of various cephalometric superimposition methods, there remains a need to assess which one can be used in daily practice with reasonably accuracy and less working time. OBJECTIVE: The aim of this study was to investigate four methods of cephalometric superimposition by means of assessing the longitudinal changes in craniofacial morphology caused by growth and response of adolescents with Class I malocclusion to orthodontic treatment involving first premolar extraction. METHODS: Pretreatment (T1) and post-treatment (T2) standardized lateral cephalometric radiographs of 31 adolescents (20 females and 11 males), with Angle Class I malocclusion and indication of premolar extraction, participated in this study. Radiographs were digitized, traced and had structures identified by means of a cephalometric software. Four superimposition methods were used: Björk structural method, Steiner/Tweed SN line, Ricketts N-Ba line at N-point and Ricketts N-Ba line at CC-point. Positional changes were quantified by horizontal and vertical linear changes in the following cephalometric landmarks: anterior/posterior nasal spine (ANS and PNS), gnathion (Gn), Gonion (Go), Pogonion (Pog), A-point and B-point. Differences between T1 and T2 in horizontal and vertical positional changes for all superimposition methods were assessed by one-way analysis of variance (ANOVA) and Bonferroni correction (p < 0.05). RESULTS: There were no statistically significant differences among the cephalometric superimposition methods or when patients' sex was considered. CONCLUSION: Björk structural method, Steiner/Tweed SN line, Ricketts N-Ba line at N-point and Ricketts N-Ba line at CC-point methods were reliable and presented similar precision when the overall facial changes due to active growth and/or orthodontic treatment were examined. .

INTRODUÇÃO: apesar dos debates sobre os méritos dos vários métodos de sobreposição cefalométrica, ainda há necessidade de se avaliar quais deles poderiam ser utilizados na prática diária, com razoável precisão e menor tempo de trabalho. OBJETIVO: o objetivo desta pesquisa foi investigar quatro métodos de sobreposição cefalométrica, avaliando as mudanças longitudinais na morfologia craniofacial causadas pelo crescimento e resposta ao tratamento, em adolescentes com má oclusão de Classe I tratados ortodonticamente com extração de primeiros pré-molares. MÉTODOS: foram usadas telerradiografias laterais pré-tratamento (T1) e pós-tratamento (T2) de 31 adolescentes (20 do sexo feminino e 11 do sexo masculino), com Classe I de Angle e indicação de extração de pré-molares. As radiografias foram digitalizadas, traçadas e as estruturas, identificadas com um software cefalométrico (Radiocef, Radio Memory, Belo Horizonte, Brasil). Quatro métodos de sobreposição foram utilizados para avaliar mudanças de posição devidas ao crescimento e/ou tratamento: método Estrutural de Björk; método Steiner/Tweed linha SN; Ricketts linha N-Ba no ponto N; e Ricketts linha N-Ba no ponto CC. As mudanças posicionais avaliadas pelos métodos de sobreposição foram quantificadas por mudanças lineares horizontais e verticais nos seguintes pontos cefalométricos: espinha nasal anterior (ENA), espinha nasal posterior (ENP), gnátio (Gn), Gônio (Go), Pogônio (Pog), Ponto A e Ponto B. Mudanças de posição horizontal e vertical entre T1 e T2 para todos os métodos de sobreposição foram avaliadas por análise de variância (ANOVA) e teste de Bonferroni (p < 0,05). RESULTADOS: não houve diferença estatística significativa entre os métodos de sobreposição cefalométrica em toda a amostra ou quando o sexo dos pacientes foi considerado. CONCLUSÃO: de acordo com a metodologia aplicada nesse estudo, os métodos de sobreposição cefalométrica Estrutural de Björk, de Steiner/Tweed linha SN, ...

Uma estratégia clínica para reabilitar a maxila atrófica com enxertos ósseos da calvária, implantes dentários temporários e definitivos: acompanhamento clínico de cinco anos / A clinical strategy to rehabilitate the atrophic maxilla with calvarial bone grafts, temporary and defi nitive implants: a 5-year follow-up report

O objetivo deste caso clínico foi relatar o tratamento de uma discrepância maxilomandibular de 5 mm através de enxertos da calota craniana para futura colocação de implantes dentários. Uma paciente de 65 anos de idade queixava-se da dificuldade de mastigar e do suporte labial inadequado com sua prótese total superior. Após a anamnese, exames intra e extraoral e por imagem, oito blocos ósseos foram removidos da calota craniana e fixados na região vestibular do rebordo alveolar. Depois, seis implantes (3,5-4,5 mm x 8-11 mm) foram colocados na maxila, porém, com a prótese provisória ficando suportada apenas por dois implantes provisórios (2,5 x 18 mm) para aguardar o tempo de consolidação do enxerto e dos implantes definitivos. Após cinco anos de acompanhamento, esta estratégia clínica se mostrou efetiva na estabilidade da correção do suporte labial e da discrepância maxilomandibular...

The aim of this clinical case was to report the treatment of a 5 mm maxillomandibular discrepancy using calvarial bone grafts for further dental implant placement. A 65-years-old patient had claims of poor mastication and inadequate lip support with her complete denture. After clinical and tomographic exams, 8 bone blocks were harvested from the calvarium region and secured at the buccal aspect of the alveolar maxillary ridge. After, six implants (3.5-4.5 mm x 8-11 mm) were installed; however, the provisional prosthesis was supported only by two provisional implants (2.5 x 18 mm) allowing for proper graft consolidation and implant osseointegration. After fi ve years of follow-up, this clinical strategy proved to be efficient to stabilize the lip support and the maxillomandibular discrepancy...