Acoustic Measurements of Speech and Voice in Men with Angle Class II, Division 1, Malocclusion

Abstract Introduction The acoustic analysis of speech (measurements of the fundamental frequency and formant frequencies) of different vowels produced by speakers with the Angle class II, division 1, malocclusion can provide information about the relationship between articulatory and phonatory mechanisms in this type of maxillomandibular disproportion. Objectives To investigate acoustic measurements related to the fundamental frequency (F0) and formant frequencies (F1 and F2) of the oral vowels of Brazilian Portuguese (BP) produced by male speakers with Angle class II, division 1, malocclusion (study group) and compare with men with Angle class I malocclusion (control group). Methods In total, 60 men (20 with class II, 40 with class I) aged between 18 and 40 years were included in the study. Measurements of F0, F1 and F2 of the seven oral vowels of BP were estimated from the audio samples containing repetitions of carrier sentences. The statistical analysis was performed using the Student t-test and the effect size was calculated. Results Significant differences (p-values) were detected for F0 values in five vowels ([e], [i], [o], [o] and [u]), and for F1 in vowels [a] and [ɔ], with high levels for class II, division 1. Conclusion Statistical differences were found in the F0 measurements with higher values in five of the seven vowels analysed in subjects with Angle class II, division 1. The formant frequencies showed differences only in F1 in two vowels with higher values in the study group. The data suggest that data on voice and speech production must be included in the protocol's assessment of patients with malocclusion.

Acoustic Measurements of Speech and Voice in Men with Angle Class II, Division 1, Malocclusion.

Introduction The acoustic analysis of speech (measurements of the fundamental frequency and formant frequencies) of different vowels produced by speakers with the Angle class II, division 1, malocclusion can provide information about the relationship between articulatory and phonatory mechanisms in this type of maxillomandibular disproportion. Objectives To investigate acoustic measurements related to the fundamental frequency (F0) and formant frequencies (F1 and F2) of the oral vowels of Brazilian Portuguese (BP) produced by male speakers with Angle class II, division 1, malocclusion (study group) and compare with men with Angle class I malocclusion (control group). Methods In total, 60 men (20 with class II, 40 with class I) aged between 18 and 40 years were included in the study. Measurements of F0, F1 and F2 of the seven oral vowels of BP were estimated from the audio samples containing repetitions of carrier sentences. The statistical analysis was performed using the Student t -test and the effect size was calculated. Results Significant differences ( p -values) were detected for F0 values in five vowels ([e], [i], [ᴐ], [o] and [u]), and for F1 in vowels [a] and [ᴐ], with high levels for class II, division 1. Conclusion Statistical differences were found in the F0 measurements with higher values in five of the seven vowels analysed in subjects with Angle class II, division 1. The formant frequencies showed differences only in F1 in two vowels with higher values in the study group. The data suggest that data on voice and speech production must be included in the protocol's assessment of patients with malocclusion.

Three-segment versus 2-segment surgically assisted rapid maxillary expansion.

OBJECTIVE: To compare the 2 surgically assisted rapid maxillary expansion (SARME) techniques, the conventional 2-segment osteotomy between maxillary central incisors and the 3-segment osteotomy between maxillary lateral incisors and canines bilaterally. Authors hypothesized that the 3-piece would provide better bone expansion. STUDY DESIGN: A pilot study was conducted; 19 patients were divided into 2 groups: conventional 2-segment osteotomy (10 patients) and 3-segment osteotomy (9 patients). Dental and skeletal measurements of the preoperative and postoperative cone beam computed tomography images were analyzed. Pre- and postoperative periodontal probing was performed, patients' cosmetic perception was evaluated in a colored visual analog scale (VAS), and surgical time was measured with a regular chronometer. RESULTS: Three-segment SARME resulted in greater bone expansion (5.12 vs 6.20 mm; P = .016), less molar inclination (7.16 vs 3.57 degrees; P = .028), better patient cosmetic perception (3.13 vs 7.68 in a VAS; P = .000), and longer surgical time (43 vs 52 minutes; P = .026). Furthermore, the 2-segment group presented necrosis of 1 central incisor. CONCLUSIONS: Results suggest that 3-piece SARME is more effective for bone expansion of the maxilla.

Impact of orthognathic surgery on quality of life and comparison of patients' postoperative experience after single- and double-jaw surgery: a longitudinal study.

OBJECTIVE: To evaluate the impact of orthognathic surgery on quality of life (QoL) and to compare single- and double-jaw surgeries in terms of ratio and patient perceptions of the postoperative period. STUDY DESIGN: A prospective, longitudinal observational study was conducted. The short form Oral Health Impact Profile (OHIP-14) and the Orthognathic Quality of Life Questionnaire (OQLQ) were applied preoperatively and 6 months postoperatively to evaluate oral health-related QoL (OHRQoL). Additionally, patient perceptions of the immediate postoperative period were assessed at the first and fourth week after surgery. RESULTS: One hundred consecutive patients were recruited and assigned to the single-jaw group (n = 24) or the double-jaw group (n = 76) according to the characteristics of each facial or occlusal deformity. The questionnaires showed lower scores for both groups after surgery, indicating significant benefits to OHRQoL. The whole sample OHIP-14 mean total scores decreased from 10.5 to 2.8 (P < .001, d = 1.35), whereas OQLQ showed a decrease from 48.4 to 11.6 (P < .001, d = 1.75). CONCLUSIONS: Orthognathic surgery can improve OHRQoL, and long-term benefits outweigh the risks and discomfort associated with the treatment.

Immediate three-dimensional changes in the oropharynx after different mandibular advancements in counterclockwise rotation orthognathic planning.

BACKGROUND: A retrospective cohort study was performed to evaluate the immediate effect on the oropharynx dimensions from different mandibular advancements in patients undergone counterclockwise rotation (CCW) of the maxillomandibular complex. MATERIAL AND METHODS: 138 CBCT images of patients, who had undergone orthognathic surgery, were identified from Dolphin Imaging archive according to pre- (T0) and post-operative (T1) times. Each pre-operative CBCT image was selected considering retrognathic mandible. Superimpositions of CBCT images were performed to measure mandibular advancement at B point in millimeters (mm) and divided into three groups: G1 (< 5 mm), G2 (between 5 and 10 mm) and G3 (> 10 mm). For evaluating oropharynx dimension at T0 and T1 for each group, medial sagittal area (MSA), volume, and minimum cross-sectional axial area (CSA) were measured on Dolphin Imaging. Pearson correlation verified reliability of method. Paired t-test were applied to compare values of measurements between T0 and T1 (p ≤ 0.05). RESULTS: 88 CBCT images were included. Method was reliable (r ≥ 0.93). According to MSA, volume and CSA values from G1, there was no significant difference between T0 and T1. CSA values presented significant difference comparing T0 and T1 in G2 (p ≤ 0.05). In subjects of G3, measurements increased in T1 significantly affecting oropharynx dimension. CONCLUSIONS: MSA, volume and CSA values showed a significant increase affecting upper airway in advancements higher than 10 mm. Mandibular advancement range showed different effects in the airway space and should be considered to achieve favorable post-operative results in the oropharynx dimensions. Key words:Retrognathia, orthognathic surgery, three-dimensional imaging, oropharynx, airway.

Planejamento interdisciplinar da correção da classe III esquelética com desgastes incisais / Interdisciplinary planning of skeletal class III correction with incisal wear

Resumo Este artigo apresenta um caso clínico cujo plano de tratamento interdisciplinar contemplou uma abordagem ortodôntico-cirúrgica previamente à fase de reabilitação oral em paciente do sexo feminino, adulta, portadora de má oclusão dentária e esquelética de Classe III e com desgastes dentários. A paciente relatou queixa estética da face e do sorriso e o exame extraoral mostrou o terço inferior da face reduzido e ausência de exposição de incisivos superiores com lábios em repouso. Ao exame intraoral, constatou-se a presença da relação de Classe III de molares e caninos, mordida cruzada anterior e desgastes dentários com encurtamento da altura dos incisivos e redução da dimensão vertical de oclusão. Ao final do tratamento, obteve-se Classe I de Angle em molares e caninos, melhora das proporções faciais e da relação sagital entre maxila e mandíbula. O tratamento ortodôntico cirúrgico proveu uma oclusão dentária favorável à reabilitação oral com recuperação da dimensão vertical da oclusão, reconstrução dos incisivos e provendo oclusão com estética e função satisfatórias. Este trabalho demonstra a importância e necessidade de uma abordagem interdisciplinar no tratamento da má oclusão esquelética e dentária da Classe III, além de uma interlocução clara entre os profissionais envolvidos. (AU)

Abstract This paper shows a case report in which interdisciplinary treatment plan comprised a surgically assisted orthodontic approach previously to the oral rehabilitation in a female, adult patient with dental and skeletal Class III malocclusion and tooth wear. The patient complained about her smile and face aesthetics and the extraoral exam revealed reduced lower lower facial third and absence of upper incisors exposure upper incisor exposure at rest. Intraoral exam exhibited molar and canine Class III relationship, anterior crossbite, tooth wear, shortening of incisors height and reduced occlusal vertical dimension. As treatment results, molar and canine class I relationship was obtained, as well as improvement of the facial proportions and sagittal relation between maxilla and mandible. The surgically assisted orthodontic treatment provided a dental intercuspation favorable to oral rehabilitation, restoring occlusal vertical dimension, reshaping the incisors, and providing occlusion with satisfactory aesthetics and function. This paper demonstrates the importance and necessity of an interdisciplinary approach on the treatment of dental and skeletal Class III malocclusion and clear communication of all the professionals involved. (AU)

Sleep-disordered breathing following mandibular setback: a systematic review of the literature.

INTRODUCTION: A mandibular setback reduces space in the pharyngeal airway, and it has been suggested that it might induce sleep-disordered breathing. OBJECTIVES: An evidence-based literature review was conducted to identify the effect of mandibular setback on the respiratory function during sleep. METHODS: The authors performed a systematic review of pertinent literature published up to 2014. A structured search of literature was performed, with predefined criteria. A survey of the PubMed, ScienceDirect, and Cochrane database was performed. A manual search of oral and maxillofacial surgery-related journals was accomplished. Potentially relevant studies then had their full-text publication reviewed. RESULTS: A total of 1,780 publications were evaluated, through which nine papers (seven case series and two case-control studies) were selected for the final review. No evidence of sleep disorder after six months was related in 223 patients. In one study, two patients developed obstructive sleep apnea syndrome after surgery, and in another two studies, seven patients presented an increase of obstructive apneas/hypopneas events and oxygen desaturation index. Most of the patients analyzed were young and thin. CONCLUSION: There was no evidence of postoperative sleep apnea syndrome after a mandibular setback surgery. However, one should always consider a potential reduction of the upper airway space during the treatment plan. Obese patients and those submitted to large amounts of mandibular setbacks present a higher chance to develop obstructive sleep apnea syndrome.

Sorriso gengival: limitações e possibilidades da Cirurgia Ortognática / Gingival smile: limitations and possibilities of orthognathic surgery

A exposição exagerada da gengiva no sorriso cria um aspecto antiestético, e requer tratamento. Apesar de o objetivo final do tratamento ser um bem claro - eliminar o sorriso gengival -, vários caminhos podem ser realizados para tratar essa condição, que pode ter como causa a hiperplasia gengival, a hiperfunção da musculatura perilabial ou, até mesmo, o crescimento exagerado da maxila no eixo vertical. O primeiro passo no tratamento dessa condição é diagnosticar sua etiologia. Dependendo da causa do sorriso gengival, o tratamento pode variar desde uma simples remoção de milímetros de osso, e reposicionamento superior da maxila. O objetivo de presente artigo é demonstrar diferentes tipos de sorriso gengival, e discutir como a cirurgia ortognática pode ser útil no tratamento dessa patologia.

Conduta cirúrgica em terceiro molar incluso com geminação / Surgical conduct for impacted third molar with gemination

Este trabalho objetiva apresentar o relato de paciente, sexo feminino, 29 anos de idade que compareceu para exodontia do elemento 38 parcialmente erupcionado. Na radiografia panorâmica observa-se o 38 associado a elemento dentário extranumerário, que se estende do rebordo a bem próximo a basilar, ultrapassando os limites do canal mandibular. Na tomografia cone beam observa-se coroa com diâmetro mesiodistal comproporções elevadas, sendo uma coroa dentária, uma câmara pulpar ampliada e três raízes, compatível com geminação. Duas das raízes estavam acima do canal mandibular e uma abaixo. A conduta cirúrgica proposta foi remoção da coroa e das raízes superiores e sepultamento da inferior, para evitar fratura mandibular e parestesia. Realizou-se acesso, osteotomia para exposição da coroa dentária até a região das furcas, seguida odontosecção para separação da coroa das raízes, clivagem e remoção da coroa. Na remoção do fragmento coronário observa--se presença da raiz mais profunda aderida a coroa, não sendo possível realizar clivagem total. As raízes superiores ao canal foram removidas sem maiores problemas. O alvéolo foi curetado, o retalho reposicionado na sua posição, seguido de sutura. Ressalta-se a importância da solicitação de exames de imagem e do planejamento de modo a evitar possíveis complicações no ato cirúrgico.

This paper reports the case of a 29-year-old female patient who visited the dental clinic for the extraction of partially eruption tooth 38. The panoramic radiograph revealed that tooth 38 was associated with an extranumerary tooth extending from the rim to near the basal lamina, surpassing the limits of the mandibular canal. Cone-beam tomography revealed a dental crown with a large mesio-distal diameter, large pulp chamber and three roots, compatible with gemination. Two of the rootswere above the mandibular canal and one was below. The proposedsurgical conduct was the removal of the crown and upper roots and burying of the lower root to avoid mandibular fracture and paresthesia. The region was accessed and osteotomy was performed to expose the dental crown to the furcation region, followed by sectioning for the separation of the crown from the roots, cleavage and removal of the crown. During this procedure, it was noted that the deepest root was adhered to the crown and complete cleavage was not possible. The roots above the canal were removed without incident. The alveolus was curetted and the flap was repositioned and sutured. This case underscores the importance of imaging exams and adequate planning toavoid possible complications during the act of surgery.

Inter-relação periodontia-prótese na odontologia restauradora: relato de caso clínico / Interrelation of periodontics and prosthodontics in restorative dentistry: clinical case report

Na busca por uma composição agradável no sorriso, alguns fatores estéticos devem ser observados, para orientação na execução dos trabalhos clínicos. Produzir harmoniosas restaurações torna-se mais difícil sem um pensamento multidisciplinar. Este artigo tem por objetivo demonstrar uma abordagem clínica interdisciplinar, a qual visou a solucionar um descontentamento estético por meio de uma parceria prótese-periodontia.

While searching for a nice composition of the smile, some esthetic factors should be observed, to guide the clinical work. Producing harmonious restorations in more difficult without a multidisciplinary approach. The aim of this article is to demonstrate an interdisciplinary clinical approach, in order to solve an esthetic dissatisfaction through a prosthesis-periodontics partnership.

Comparative analysis of two different alar base sutures after Le Fort I osteotomy: randomized double-blind controlled trial.

OBJECTIVE: The aim of this prospective study was to analyze the efficacy of a new alar base cinch suture by comparing it with the commonly used cinch suture described by Schendel and Delaire in Dr. William Bell's book. STUDY DESIGN: Thirty-five patients submitted to maxillary impaction and/or advancements of ≥ 3 mm were randomly divided into 2 groups. Group 1 received an extra oral alar base cinch suture, and patients from group 2 received the classic intraoral suture. Alar and alar base width were measured before and after surgery in digital photographs, with the patient's head in a submental oblique view. Data were reported as means and standard deviations, and difference between groups were determined using Welch t test. A P value of <.05 was considered to be statistically significant. RESULTS: Mean alar base widening was 1.38 mm in group 1 and 2.5 mm in group 2, and mean alar widening was 1.40 mm in group 1 and 2.31 mm in group 2. The difference was statistically significant (P < .05). CONCLUSION: Extraoral alar base cinch suture was more effective in maintaining preoperative Alar and alar base width compared with classic intraoral nasal suture.

Avoiding condylar displacement after intraoral vertical ramus osteotomy.

The intraoral vertical osteotomy is a versatile and simple technique usually applied to correct mandibular prognathism. Its greatest advantages include ease of performance and minimum neurosensory disturbances, whereas maxillomandibular fixation is pointed as its major disadvantage. Another important concern about this technique is condylar displacement, which may lead to temporomandibular dysfunction. Technical notes to avoid condylar luxation are discussed after 15 years of experience using this osteotomy as the technique of choice to correct mandibular prognathism. Three similar cases are presented, where 1 condyle was displaced from the glenoid fossa, resulting in mandibular deviation during function in patients requiring small mandibular setback.

Estudo clínico randomizado duplo cego comparando duas técnicas de plicatura nasal após osteotomias tipo Le Fort I / Randomized double blind controlled Trial comparing two different alar base sutures following Le Fort I osteotomy

A correção de deformidades esqueléticas da face por meio de um tratamento ortodôntico-cirúrgico tornou-se uma opção segura e previsível. Os movimentos ósseos são milimetricamente calculados e executados cirurgicamente, assim como a oclusão é meticulosamente engrenada através dos movimentos ortodônticos. Os efeitos que os tecidos moles sofrem com as cirurgias ortognáticas são, no entanto, menos previsíveis, e apesar do principal objetivo da cirurgia ortognática ser uma melhora funcional, o componente estético é sem dúvida de extrema importância. Em especial, a região de base alar apresenta resultados muito variáveis, a despeito dos bons resultados esqueléticos atingidos. O objetivo deste estudo foi comparar 2 diferentes tipos de sutura utilizados na região de base do nariz, e observar qual tipo apresenta um resultado que melhor acompanhe os movimentos realizados pelo tecido esquelético. Trinta e cinco pacientes foram aleatoriamente distribuídos em 2 grupos. O grupo 1 funcionou como controle e os pacientes receberam a plicatura nasal intra-oral, que é o tipo de plicatura nasal mais descrito na literatura. Já os pacientes do grupo 2 receberam plicatura nasal extra-oral. Para análise estatística foram calculadas as médias e desvios padrões dos grupos, e a hipótese nula de que não havia diferença entre os 2 grupos foi testata com o teste T de Student. Em ambos os grupos ocorreu um alargamento da base do nariz, porém a média de alargamento do grupo 1 foi de 2,50 milímetros (mm), enquanto que a média de alargamento do grupo 2 foi de 1,26 mm. Além disso, o desvio padrão foi menor para o grupo 2, e a hipótese nula foi rejeitada (p<0,05), demonstrando que a diferença entre os grupos foi estatisticamente significativa. Pôde-se concluir que quando objetiva-se um controle mais previsível e rigoroso da base do nariz, a plicatura nasal extra-oral cumprirá melhor esta função.

Correction of skeletic deformities through a surgical-orthodontic approach hás become a safe and predictable option. Bone movements are meticulously calculated and surgically executed, while the occlusion is tightly adjusted through orthodontic movements. Soft tissue response to orthognathic surgery are, however, less predictable, and although the purpose of the orthognathic surgery is to improve function, the cosmetic component is undoubtedly of extreme importance. In special the alar base region presents variables results, regardless of the good skeletic results achieved. The objective of this trial was to compare 2 different sutures applied to the alar base region, and to analyze which one would present a better result. Thirty Five patients were randomly distributed into 2 groups. Group 1 received the intraoral nasal plicature, and worked as the control group, since this is the most conventional type of suture applied to this region. Patients from group 2 received an extra oral nasal plicature. The statistical analysis was performed comparing the mean and standard deviation of both groups. Also, the null hypothesis that there was no difference between the groups was tested with T Student’s test. Both groups presented wider nasal bases in the postoperative. However, group 1 mean was 2.50 millimeters (mm), while group 2 mean was 1.26. Besides, standard deviation was lower in the experimental group, and the null hypothesis was rejected (p<.05), showing a statistical difference between the groups. It can be concluded that when the purpose is to have a more predictable and rigorous control of the alar base width, the extra oral plicature will work better.

Rehabilitation of an adolescent with ectodermal dysplasia. Two-stage orthognathic, graft, and implant surgery: case report.

A 16-year-old girl presenting with ectodermal dysplasia has undergone double jaw orthognathic surgery to correct mandibular prognathism and maxillary anteroposterior deficiency. Ten months later the patient had a second surgery that included the placement of 11 implants along with bone grafting to the maxilla and mandible. Fourteen months after the second surgery, the definitive ceramic work was fabricated and screw retained. Even though the patient was still an adolescent at the time of the first surgery, psychological effects of the deformity may require an early solution for this kind of patient.

Cirurgia oral em pacientes com distúbios de sangramento. Como proceder? / Oral surgery in patients with bleeding disordes. What to do?

Foi realizada uma revisão de estudos comparando pacientes sob regime de anticoagulantes orais ou aspirina submetidos a cirurgia oral. Esses estudos tentaram esclarecer se o sangramento apresentado pelos pacientes durante a cirurgia justificava ou não o risco de interromper a medicação. A maior parte da literatura mostrou que, na maioria das vezes, não há necessidade de suspender a medicação dependendo da extensão do procedimento. Manobras cirúrgicas podem ser utilizadas para controlar o sangramento e reduzir os riscos de tromboembolismo ou outras complicações relacionadas à interrupção de medicação. No entanto, é necessário avaliar os exames laboratoriais e discutir com o médico do paciente.