Three-dimensional analysis of posterior tooth inclinations in transverse and sagittal relationships: A cross-sectional study.

OBJECTIVE: To compare tooth inclinations in different sagittal skeletal patterns and transverse maxillary relationships three-dimensionally. METHODS: A cross-sectional study carried out with 132 three-dimensional digital models in the complete permanent dentition divided into six groups (n=22); three groups with maxillary atresia: G1- skeletal class I, G2- skeletal class II and G3-skeletal class III; three groups without maxillary atresia: G4- skeletal class I; G5- skeletal class II and G6- skeletal class III. The comparison between the skeletal pattern was performed by the non-parametric tests of Kruskal Wallis and Dunn and between the groups by the non-parametric test of Mann Whitney. RESULTS: Subjects with skeletal class II and maxillary atresia had a greater lingual inclination of the maxillary teeth than those with class I and III; Subjects with skeletal class II without atresia had a less lingual inclination of the mandibular molars than the other classes (p<0.05). The maxillary premolars showed no variation in dental inclination with atresia, independent of the skeletal class in G1, G2, and G3 (p>0.05). The mandibular premolars showed that the groups without atresia G4, G5, and G6 presented no significant difference (p>0.05). Lower premolars in skeletal class III malocclusion individuals with atresia had a more negative inclination than the others. CONCLUSION: There is a difference in the inclination of posterior teeth between individuals with and without maxillary atresia and skeletal classes I, II, and III.

Characterization of Mandibular Border Movements and Mastication in Each Skeletal Class Using 3D Electromagnetic Articulography: A Preliminary Study.

Mandibular movement recording is relevant for the planning and evaluation of mandibular function. These movements can include mandibular border movements (MBM) or mastication. Our objective was to characterize the kinematics of MBM and mastication among skeletal classes I, II, and III in the three spatial planes. A descriptive cross-sectional study was conducted with 30 participants. Instructions were provided on how to form Posselt's envelope and to perform masticatory. After data processing, we obtained numerical values for the areas, trajectories, and ranges of MBM that formed Posselt's envelope and the values for speed, masticatory frequency, and the areas of each masticatory cycle. Significant differences were found in the area of Posselt's envelope in the horizontal plane between skeletal classes I and III and in the range of right laterality between skeletal classes II and III. Mastication showed significant differences in the area of the masticatory cycles in the horizontal plane between classes I and III and between classes II and III. In conclusion, there were differences in MBM and mastication between skeletal classes III and I in the horizontal plane. This study supports the need to establish normal values for mandibular kinematics in skeletal class III.

Evaluation of Head and Cervical Spine Posture after Therapy with Maxillary Protraction Appliances / Evaluación de la Postura de la Cabeza y la Columna Cervical Después de la Terapia con Aparatos de Protracción Maxilar

SUMMARY: The objective of this study was to evaluate the changes of head and cervical spine posture of skeletal class malocclusion in adolescent with maxillary protraction. Thirty cases of skeletal class malocclusion were randomly selected from the Stomatological Hospital of Shanxi Medical University. High-quality lateral cephalograms were collected including pre- and posttreatment to compare the changes of head and cervical spine posture. Data were processed using SPSS 26.0 statistical software. The paired-t test was used to compare pre- and posttreatment mean angular measurements.A significant difference in the SNA(p<0.001), SNB(p<0.01), and ANB(p<0.001) between T1 and T2 showed an improvement in the sagittal relationships. A significant change was observed in middle cervical spine posture, while upper cervical spine posture variables showed no significant difference after treatment. Skeletal class with maxillary protraction appliance not only led to the improvement of sagittal relationship, but also changed the middle cervical spine posture.

El objetivo de este estudio fue evaluar los cambios en la postura de la cabeza y la columna cervical debido a la maloclusión clase esquelética en adolescentes con protracción maxilar. Treinta casos de maloclusión de clase esquelética fueron seleccionados al azar del Hospital Estomatológico de la Universidad Médica de Shanxi. Se recogieron cefalogramas laterales de alta calidad, incluidos el tratamiento previo y posterior, para comparar los cambios en la postura de la cabeza y la columna cervical. Los datos se procesaron con el software estadístico SPSS 26.0. Se utilizó la prueba t pareada para comparar las medidas angulares medias antes y después del tratamiento. Una diferencia significativa en SNA (p <0,001), SNB (p <0,01) y ANB (p <0,001) entre T1 y T2 mostró una mejora en las relaciones sagitales. Se observó un cambio significativo en la postura de la columna cervical media, mientras que las variables de postura de la columna cervical superior no mostraron diferencias significativas después del tratamiento. La clase esquelética con aparato de protracción maxilar no solo condujo a la mejora de la relación sagital, sino que también cambió la postura de la columna cervical media.

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

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

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

Estudio comparativo de la posición natural de cabeza entre las clases esqueléticas mediante fotogrametría facial / Comparative study of the natural head position between skeletal classes using facial photogrammetry

El objetivo de esta investigación es evaluar si existen diferencias en la inclinación de la Posición Natural de Cabeza (PNC) entre las clases esqueléticas, mediante fotogrametría. Para esto se realizó un estudio observacional analítico de corte transversal. La muestra fue de 45 voluntarios de entre 18 y 50 años. Se determinó la clase esquelética mediante análisis de Steiner y Wits, en radiografías laterales de cráneo, utilizando el software BlueSkyPlan®. A cada participante se le tomó una fotografía de perfil en PNC. Posteriormente, en Photoshop®, se trazó un plano entre los puntos tragion y exocanto (plano t-ex) y la horizontal verdadera, para finalmente medir el ángulo formado en el programa UTHSCSA ImageTool3.0®, determinando así la inclinación de la cabeza. Luego de tabular los datos, se realizaron análisis estadísticos. Este estudio evidenció una diferencia de 6,68° en promedio en la inclinación de la PNC entre los pacientes clase II y I esquelética, con significación estadística, por lo que se concluye que los pacientes clase II esquelética tienen una PNC más inclinada en sentido horario respecto a los pacientes clase I, en la muestra analizada. Los pacientes clase III no mostraron diferencias.

The objective of this research is to evaluate the differences in the inclination of the Natural Head Position (NHP) between skeletal classes, using photogrammetry. For this, a cross-sectional analytical observational study was carried out. The sample consisted of 45 volunteers between 18 and 50 years old. The skeletal class was determined by Steiner and Wits analysis, in lateral skull radiographs, using the BlueSkyPlan® software. Each participant had a profile photograph taken at NHP. A plane was drawn between the tragion and exocanthion points and the true horizontal using Photoshop®, and the angle was measured using UTHSCSA ImageTool3.0® software, assessing the inclination of the head. After data tabulation, statistical analyses were performed. This study showed an average difference of 6.68° in the inclination of the NHP between skeletal class II and I patients, with statistical significance. It was concluded that skeletal class II patients have a more inclined NHP in a clockwise direction compared to class I patients, in the analyzed sample. Class III patients did not show differences.

Effects of different force directions of intra-oral skeletally anchored maxillary protraction on craniomaxillofacial complex, in Class III malocclusion: a 3D finite element analysis

ABSTRACT Introduction: The intra-oral skeletally anchored maxillary protraction (I-SAMP) has been found to be an effective treatment for skeletal Class III malocclusion. Objective: This in-silico study explored the influence of different force directions of intra-oral skeletally anchored Class III elastics on the changes in craniomaxillofacial complex, using finite element analysis. Methods: A 3-dimensional (3D) finite element model of the craniomaxillofacial bones including circummaxillary sutures was constructed with high biological resemblance. A 3D assembly of four miniplates was designed and fixed on the maxilla and mandible of the finite element model. The model was applied with 250g/force at the miniplates at three angulations (10°, 20°, and 30°) from the occlusal plane, to measure stress and displacement by using the ANSYS software. Results: The zygomaticotemporal, zygomaticomaxillary, and sphenozygomatic sutures played significant roles in the forward displacement and counterclockwise rotation of maxilla and zygoma, irrespective of the angulation of load application. The displacements and rotations of the zygomatico-maxillary complex decreased gradually with an increase in the angle of load application between miniplates from 10° to 30°. The mandible showed negligible displacement, with clockwise rotation. Conclusions: The treatment effects of I-SAMP were corroborated, with insight of displacement patterns and sutures involved, which were lacking in the previously conducted 2D and 3D imaging studies. The prescribed angulation of skeletally anchored Class III elastics should be as low as possible, since the displacement of zygomatico-maxillary complex increases with the decrease in angulation of the elastics.

RESUMO Introdução: A protração maxilar com ancoragem esquelética intrabucal (I-SAMP) tem sido considerada um tratamento efetivo para a má oclusão esquelética de Classe III. Objetivo: O presente estudo in silico avaliou, usando análise de elementos finitos, a influência de diferentes direções da força dos elásticos Classe III com ancoragem esquelética intrabucal nas mudanças no complexo craniomaxilofacial. Métodos: Um modelo de elementos finitos tridimensional (3D) dos ossos craniomaxilofaciais, incluindo as suturas circum-maxilares, foi construído, com alta semelhança biológica. Uma montagem 3D de quatro miniplacas foi projetada e fixada na maxila e na mandíbula do modelo de elementos finitos. O modelo foi aplicado com o uso de 250g/força nas miniplacas em três angulações (10°, 20° e 30°) em relação ao plano oclusal, para medir as tensões e os deslocamentos, usando o programa ANSYS. Resultados: As suturas zigomaticotemporal, zigomaticomaxilar e esfenozigomática desempenharam um papel significativo no deslocamento para anterior e na rotação anti-horária da maxila e do zigoma, independentemente da angulação na aplicação da força. Os deslocamentos e as rotações do complexo zigomático-maxilar diminuíram gradualmente com o aumento de 10° para 30° no ângulo de aplicação da força entre as miniplacas. A mandíbula apresentou deslocamento irrelevante, com rotação no sentido horário. Conclusões: Os efeitos do tratamento com I-SAMP foram corroborados, com um vislumbre dos padrões de deslocamento e das suturas envolvidas, que não existiam nos estudos com imagens 2D e 3D realizados anteriormente. A angulação dos elásticos Classe III ancorados esqueleticamente deve ser a menor possível, visto que o deslocamento do complexo zigomático-maxilar aumenta com a redução no ângulo dos elásticos.

Clase III esqueletal ­ cuando todas las estrategias son insuficientes: reporte de un caso clínico / Skeletal class III - when all strategies are insufficient: report of a clinical case

Desde la antigüedad la belleza y la armonía facial han sido objetivos que tanto pintores como escultores, médicos y las personas tratan de lograr. Los rostros han sido estereotipados y es así como las caras proporcionadas tanto en alto como en ancho con perfiles que son rectos o levemente convexos son los que se asocian a bondad, generosidad, personas con luz interior, princesas y son las "buenas de las películas". Pero ¿qué sucede con aquellos rostros cóncavos, con tercios inferiores ya largos o cortos?… a ellos les ha tocado la peor parte, son los malos, los oscuros, los "villanos de las películas". Objetivos La finalidad de este trabajo es acercar a los colegas ortodoncistas una opción de tratamiento en clase III esqueletal, cuando el camuflaje ortodóncico no alcanza para resolver el crecimiento alterado entre el maxilar superior y el maxilar inferior (AU)

Beauty and facial harmony have been, since the beginning of humanity, a target for artists, painters, sculptores, and even people and doctors to accomplish. There is a stereotype of beauty: faces with proportional dimensions both in height and length, with straight profiles or somehow convex are associated with kindness, generosity and inner beauty. We can see this in movies where the heroes, the princesses, the "good guys" are portrayed with these types of faces. And what happens with people with concave faces, long or short inferior thirds? They are doomed to be the evil, the dark and "the villains" (AU)

Assessing cervical spine and craniofacial morphology in Class II and Class III malocclusions: A geometric morphometric approach.

To compare craniofacial and cervical morphology between skeletal Classes II and III applying Geometric Morphometric Methods (GMM). Twenty-six cervical and craniofacial landmarks of 40 Class II and 39 Class III individuals were digitalized on lateral cephalograms. Procrustes ANOVA, generalized Procrustes, principal component analyses, and thin-plate spline function were applied to assess the pattern of shape variation of craniofacial structure and the cervical spine in relation to skeletal classes. Compared with Class III, Class II individuals presented a maxillary protrusion, mandibular retrusion, shorter mandibular corpus, posterior mandibular ramus rotation, anterior cranial base rotation, and a smaller centroid size. Furthermore, a forward and smaller cervical spine were observed. With GMM, the shape and size differences between skeletal classes can be analyzed visually and numerically.

Corrección de una clase III esqueletal con anclaje óseo en paciente en crecimiento: Reporte de caso / Skeletal class III correction in growing patient with bone anchorage: CaseReport

Antecedentes: La clase III esqueletal, es una deformidad dentofacial donde el tercio inferior de la cara es más prominente, el tratamiento se decide según la etiología y la edad del paciente; si se encuentra en crecimiento la malformación puede ser tratada con un protocolo interceptivo y si es posible evitar la cirugía ortognática a futuro. Objetivo: Mejorar la clase esqueletal, descruzar la mordida u obtener mordida borde a borde, mejorar la posición del labio superior y evaluar el comparativo inicial-final de SNA y ANB. Reporte de caso:Paciente masculino de 13 años, sin antecedentes personales patológicos o familiares reportados; presenta clase III esqueletal responsiva bimaxilar, crecimiento vertical, clase molar I y canina III; fue tratado con el protocolo de mini placas BAMP (bone anchored maxillary protraction) por sus siglas en inglés, elásticos intermaxilares y un paladar con pistas planas. Resultados:La fase ortopédica duro cinco meses y se logró mordida borde a borde y clase I esqueletal. Discusión: Se obtuvieron resultados con el uso de mini implantes sin anclaje extraoral en menos tiempo a comparación de otros métodos que tienen que ser usados por 9-12 meses.Conclusión:El protocolo BAMP puede ser usado en pacientes en crecimiento sin máscara facial para corregir la clase III esqueletal.

Background: Skeletal class III is a dentofacial deformity where the lower third ofthe face is more prominent. The treatment is decided according to the etiology and age of the patient; If the patient is in growing, the malformation can be treated with an interceptive protocol and if possible, avoid a orthognathic surgery in the future. Objective: Improve the skeletal class, uncross the bite or obtain an edge-to-edge bite, improve the position of the upper lip and compare the initial-final relationship of ANS and ANB.Case report:13-year-old male patient, with no reported pathological or family history; presents skeletal class III, vertical growth, molar class I and canine III; he was treated with the protocol of mini BAMP (bone anchored maxillary protraction) plates, intermaxillary elastics and a palate with flat tracks. Results:The orthopedic phase lasted five months and an edge-to-edge bite and skeletal class I were achieved.Discussion:Results were obtained with the use of mini plates without extraoralanchorage in less time compared to other methods that have to be used for 9-12 months. Conclusion: The BAMP protocol can be used in growing patients without a face mask to correct skeletal class III.

Single Nucleotide Polymorphisms in Runt-related Transcription Factor 2 and Bone Morphogenetic Protein 2 Impact on Their Maxillary and Mandibular Gene Expression in Different Craniofacial Patterns - A Comparative Study.

Introduction: This study aimed to evaluate if single nucleotide polymorphisms (SNPs) in runt-related transcription factor 2 (RUNX2) and bone morphogenetic protein 2 (BMP2) are associated with different craniofacial patterns. Furthermore, we also investigated if RUNX2 and BMP2 expression in the maxilla and mandible are differently expressed according to facial phenotypes and influenced by the SNPs in their encoding genes. Orthognathic patients were included. Materials and Methods: Lateral cephalometric radiographs were used to classify facial phenotypes based on Steiner's ANB and Ricketts' NBa-PtGn angles. Bone samples from 21 patients collected during orthognathic surgery were used for the gene expression assays. DNA from 129 patients was used for genotyping the SNPs rs59983488 and rs1200425 in RUNX2 and rs235768 and rs1005464 in BMP2. The established alpha was 5%. Results: A statistically significant difference was observed in the relative BMP2 expression in the mandible between Class I and III participants (P = 0.042). Homozygous GG (rs59983488) had higher RUNX2 expression (P = 0.036) in the mandible. In maxilla, GG (rs1200425) had a higher BMP2 expression (P = 0.038). Discussion: In conclusion, BMP2 is expressed differently in the mandible of Class I and Class III participants. Genetic polymorphisms in RUNX2 and BMP2 are associated with their relative gene expression.

Assessment of the relationship between size, shape and volume of the sella turcica in class II and III patients prior to orthognathic surgery.

PURPOSES: The main purpose of this study was to assess the measurements and shape of the sella turcica by using cone beam computed tomography (CBCT) and to associate the data to skeletal class II and class III patients, including correlations with gender, age and measurements of the anterior cranial base. MATERIAL AND METHODS: A trained examiner specialist in dental radiology selected and evaluated randomly 95 CBCT images of pre-orthognathic surgery patients, 60 (63.2%) being female and 35 (36.8%) male with age between 16 and 57 years. All images were evaluated to determine the size, shape and volume of the sella turcica. The anterior cranial base, represented by the S-N line (sella-nasion), was also measured. RESULTS: Of these 95 patients, 48 (50.5%) had class III facial skeletal pattern, whereas 47 (49.5%) had class II. No statistically significant differences were found between class II and class III patients in the measurements and shape of the sella turcica (P > 0.05). The diameter and volume of the sella turcica had higher values in female patients, whereas the measurements of the anterior cranial base were higher in males (P < 0.05). CONCLUSION: Therefore, one can conclude that measurements of the sella turcica are not reliable parameters to evaluate whether a class II or class III patient will or will not need orthognathic surgery.

Tooth agenesis-related GLI2 and GLI3 genes may contribute to craniofacial skeletal morphology in humans.

OBJECTIVE: The present cross-sectional, multi-centre, genetic study aimed to determine, whether single nucleotide polymorphisms (SNPs) in tooth agenesis (TA)-associated GLI2 and GLI3 genes contribute to the development of craniofacial skeletal morphology in humans. DESIGN: Orthodontic patients from an ethnically heterogeneous population were selected for the present study (n = 594). The presence or absence of TA was determined by analysis of panoramic radiography and dental records. The subjects were classified according to their skeletal malocclusion and facial growth pattern by means of digital cephalometric analysis. Genomic DNA was extracted from squamous epithelial cells of the buccal mucosa and SNPs in GLI2 (rs3738880, rs2278741) and GLI3 (rs929387, rs846266) were analysed by polymerase chain reaction using TaqMan chemistry and end-point analysis. RESULTS: Class II skeletal malocclusion presented a significantly lower frequency of TA (P < 0.05). Subjects without TA showed significantly higher ANB angles (P < 0.05). Genotype and/or allele distributions of the SNPs in GLI2 (rs3738880, rs2278741) and GLI3 (rs846266) were associated with the presence of TA (P < 0.05). The SNPs rs3738880, rs2278741 and rs929387 were also associated with some type of skeletal malocclusion (P < 0.05), but not with the facial growth pattern (P > 0.05). The G allele for TA-related GLI2 rs3738880 was strongly linked to the presence of Class III skeletal malocclusion (OR = 2.03; 95% CI = 1.37-3.03; P<3125 × 10-6). GLI2 rs2278741 C allele was overrepresented in individuals without TA, suggesting it as a protective factor for this dental phenotype (OR = 0.43; 95% CI = 0.24-0.78; P<625 × 10-5). CONCLUSION: The present study suggests that SNPs in TA-associated GLI2 and GLI3 genes may also play a role in the development of skeletal malocclusions. rs3738880 and rs2278741 in GLI2 seems to contribute to the genetic background for skeletal Class III and TA, respectively. TA could be an additional predictor of craniofacial morphology in some cases. Further research replicating the reported associations should be performed.

Genetic variants in ACTN3 and MYO1H are associated with sagittal and vertical craniofacial skeletal patterns.

OBJECTIVE: This study aimed to evaluate the association of genetic variants inACTN3 and MYO1H with craniofacial skeletal patterns in Brazilians. DESIGN: This cross-sectional study enrolled orthodontic and orthognathic patients selected from 4 regions of Brazil. Lateral cephalograms were used and digital cephalometric tracings and analyzes were performed for craniofacial phenotype determination. Participants were classified according to the skeletal malocclusion in Class I, II or III; and according to the facial type in Mesofacial, Dolichofacial or Brachyfacial. Genomic DNA was extracted from saliva samples containing exfoliated buccal epithelial cells and analyzed for genetic variants inACTN3 (rs678397 and rs1815739) and MYO1H (rs10850110) by real-time PCR. Chi-square or Fisher's exact tests were used for statistical analysis (α = 5%). RESULTS: A total of 646 patients were included in the present study. There was statistically significant association of the genotypes and/or alleles distributions with the skeletal malocclusion (sagittal skeletal pattern) and facial type (vertical pattern) for the variants assessed inACTN3 (P < 0.05). For the genetic variant evaluated in MYO1H, there was statistically significant difference between the genotypes frequencies for skeletal Class I and Class II (P < 0.05). The reported associations were different depending on the region evaluated. CONCLUSION: ACTN3 and MYO1H are associated with sagittal and vertical craniofacial skeletal patterns in Brazilian populations.

Aparelho de protrusão mandibular powerscope™ no tratamento das displasias crânio cérvico oclusais (dcco) ­ II com retrusão mandibular e assimetria dos arcos dentários e face ­ caso clínico / Powerscope™ mandibular protraction appliance for treatment of craniocervical occlusal dysplasia (ccod) type II associated with mandibular deficiency, facial and dental arch asymmetry ­ a clinical case

Nas últimas décadas pode-se afirmar que a Ortodontia vem sofrendo uma evolução sem precedentes. A descoberta de novos conceitos biológicos, o progresso tecnológico e a introdução de novas técnicas têm possibilitado facilitar e agilizar o tratamento de várias maloclusões, dentre elas a Classe II por retrusão mandibular. Diversos aparelhos e técnicas têm surgido nos últimos tempos e os propulsores mandibulares têm tido um destaque considerável. O presente caso clínico ilustra um tratamento ortodôntico corretivo compensatório de um paciente jovem com deficiência mandibular e assimetria através do uso do aparelho Powerscope™. Esse surge como uma alternativa para o tratamento de displasias crânio cérvico oclusais (DCCO) ­ II com retroposicionamento mandibular em pacientes com dentição permanente e relutantes ao tratamento ortodôntico-cirúrgico. De acordo com o fabricante, o aparelho possibilita maior amplitude de movimentos, maior simplicidade na instalação, bem como mais conforto e aceitação por parte do paciente. A queixa principal do presente caso consistia no tratamento da maloclusão Classe II após a falha do tratamento ortopédico funcional. A mecânica aplicada permitiu a correção da maloclusão, atingido-se relações oclusais satisfatórias de molares e caninos, bem como estéticas. Sendo possível obter uma melhoria no perfil e sorriso do paciente. O aparelho Powerscope™ revelou-se um ótimo acessório para o tratamento do presente caso clínico tendo cumprido com seu propósito, não sendo relatada qualquer intercorrência durante o seu uso. (AU)

In the last decades we can say that Orthodontics has undergone an unprecedented evolution. The discovery of new biological concepts, technological progress and the introduction of new techniques have been facilitating and accelerating the treatment of several malocclusions, among them Class II through mandibular retrusion. Several devices and techniques have emerged in recent times and the fixed functional appliances have had a considerable rise in interest. The present case report illustrates a corrective orthodontic treatment of a young patient with mandibular deficiency and asymmetry using the Powerscope™ device. This arises as an alternative for the treatment of craniocervical occlusal dysplasia (CCOD) ­ II with mandibular rebuilt in patients with permanent dentition and reluctant to orthodontic-surgical treatment. According to the appliance manufacturer, the device allows a greater range of movement, greater simplicity in the installation as well as more comfort and acceptance by the patient. The main complaint of the present case was the treatment of Class II malocclusion after failure of functional orthopedic treatment. The applied mechanics allowed the correction of the malocclusion, reaching satisfactory molars and canines occlusal relationships as well as aesthetics. It was possible to obtain an improvement in the patient profile and smile. The Powerscope™ device proved to be an excellent accessory for the treatment of the present clinical case having fulfilled its purpose and no intercurrences were reported during its use.(AU)

Micro-implanted-anchorage safety: cortical bone thickness in the maxillary posterior region of skeletal class II malocclusion / Seguridad en el micro-implante de anclaje: espesor del hueso cortical en la región posterior del maxilar en maloclusión de clase esquelética tipo II

Cone Beam Computed Tomography (CBCT) measurement of cortical bone thickness and implantation angle in the maxillary posterior region was used to provide reference for the safety of Micro-Implanted-Anchorage (MIA) implantation in skeletal class II malocclusion. Twenty samples of CBCT images were collected from orthodontics patients (ages, 12-40 years) in Shanxi Medical University Stomatological Hospital, the thickness of cortical bone was measured at 45°, 60° and 90° from the alveolar crest, being at 4 mm, 6 mm and 8 mm, respectively. SPSS17.0 statistical software was used to analyze the data, and the one-way ANOVA and LSD method were compared. There was a significant difference in the thickness of the cortical bone obtained by implanting MIA at the same height of different angle (P≤0.05). The greater the inclination angle of the implanted MIA, the thicker the cortical bone. Also, the higher the implant site, the thicker the cortical bone thickness. Finally, the greater the thickness of the cortical bone in the maxillary posterior region of skeletal class II malocclusion, the greater the thickness of the cortical bone. At the same implantation height, implanted MIA with a tilt angle of 45º to 60º, 90º to obtain the best cortical bone thickness.

La medición del grosor del hueso cortical y del ángulo de implantación en la región posterior del maxilar por tomografía computarizada de haz cónico (TCHC) se utilizó para proporcionar una referencia para la implantación y el anclaje seguros de un Micro-Implante de Anclaje (MIA) en la maloclusión de clase esquelética tipo II. Veinte muestras de imágenes de TCHC fueron obtenidas de pacientes de ortodoncia (12-40 años) en el Hospital Estomatológico de la Universidad Médica de Shanxi. Se midió el grosor del hueso cortical a 45°, 60° y 90° de la cresta alveolar, encontrándose a 4 mm, 6 mm y 8 mm, respectivamente. Se utilizó el software estadístico SPSS 17.0 para analizar los datos, y se compararon con los métodos ANOVA y LSD de un factor. Hubo una diferencia significativa en el grosor del hueso cortical obtenido al implantar el MIA a la misma altura en diferentes ángulos (P <0,05). Cuanto mayor es el ángulo de inclinación del MIA implantado, más grueso es el hueso cortical. También, cuanto más alto es el sitio del implante, más grueso es el grosor del hueso cortical. Finalmente, cuanto mayor sea el grosor del hueso cortical en la región posterior del maxilar, en la maloclusión de clase esquelética tipo II, mayor será el grosor del hueso cortical.

Quick correction of a skeletal class III maloclussion in primary dentition with face mask plus rapid maxillary expansion therapy / Corrección rápida de una maloclusión esquelética clase III en dentición primaria con máscara facial más terapia rápida de expansión maxilar

Abstract Skeletal Class III is a malocclusion characterized by anterior crossbite as a result of an abnormal skeletal maxillary and mandibular base discrepancy, which involves disharmony of craneofacial skeleton and profile. The preferred management for children having skeletal Class III malocclusion with retruded maxilla and/or prognathic mandible is the use of devices that encourage the growth and anterior movement of the maxilla bone and/or restrict the exessive mandible growth. The orthopedic treatment consisting of a face mask with rapid maxillary expansion (RME) produces the most dramatic results in the shortest period of time. The purpose of this article is to review a quick correction of skeletal class III maloclussion in the primary dentition through a case example with use of a face mask plus rapid maxillary expansion therapy in a 5 year-old male patient due to a combination of retruded maxilla and protruded mandible, in primary dentition, who was treated with a Petit face mask in conjunction with a bonded RME intraoral appliance added with bite blocks. The first evident occlusal outcomes were a clockwise rotation of the mandible, a positive overjet of 3 mm, a correct overbite, a canine Class I relationship, and a bilateral flush terminal plane. After discussing the present clinical case report and the related published literature, we concluded that skeletal class III malocclusions should be treated as soon as the first clinical signs of abnormal craniofacial growth are recognized, during the first years of life.

Resumen La clase III esquelética es una maloclusión caracterizada por mordida cruzada anterior como resultado de una discrepancia esquelética de la base maxilar y mandibular, que implica desarmonía craneofacial y del perfil. El tratamiento de elección para niños con maloclusión clase III esquelética con mandíbula maxilar y/o prognática es el uso de dispositivos que estimulan el crecimiento y el movimiento anterior del hueso maxilar y/o restringen el crecimiento excesivo de la mandíbula. El tratamiento ortopédico que consiste en una máscara facial con expansión maxilar rápida (EMR) produce resultados en un período de tiempo más corto. El propósito de este artículo es revisar una corrección rápida de la maloclusión de clase III esquelética en la dentición primaria mediante el uso de una máscara facial más terapia de expansión maxilar rápida en un paciente masculino de 5 años debido a una combinación de maxilar retruido y mandíbula prominente, en dentición primaria, que fue tratada con una mascarilla Petit junto con un dispositivo intraoral unido con bloques de mordida. Los primeros resultados evidentes fueron una rotación en sentido horario de la mandíbula, un overjet positivo de 3 mm, una sobremordida correcta, una relación canina de Clase I y un plano terminal de descarga bilateral. Después de discutir el presente informe de caso clínico y la literatura publicada relacionada, concluimos que las maloclusiones de clase III esqueléticas deberían tratarse tan pronto como se reconozcan los primeros signos clínicos de crecimiento craneofacial anormal, durante los primeros años de vida.

Morphological changes of skeletal class III malocclusion in mixed dentition with protraction combined activities / Cambios morfológicos en maloclusión de la clase esquelética III en dentición mixta con actividades combinadas de protracción

The objective of the study was to investigate the morphological changes of skeletal class III malocclusion in mixed dentition with light force protraction combined activities. Randomly selected 30 cases of orthodontics in Shanxi Medical University orthodontics patients (ages: 6-10 years) of the lateral cephalograms. Using the oral maxillary casting type of pre-traction device, according to the condition of maxillary dentition to select the corresponding activities of the movable expansion appliance, each side of the force of about 150-200 g, requiring patients to wear 10-12 hours a day, the appliance should be removed after reaching normal occlusion. The correlation cephalometric profile of the cranial lateral radiographs before and after orthodontic treatment was measured. All patients with skeletal class III malocclusion were improved, concave type became direct type, measurements SNA, ANB, A-Ptm, MP-SN, ANS-Me/N-Me increased, maxillary advancement and reconstruction are more obvious; mandible rotates clockwise; the increase of lip inclination of anterior teeth compensatory changes, lower anterior tooth inclination changes smaller; upper lip forward, nasolabial angle decreased, improved appearance significantly. Light force protraction combined activities can make the mixed dentition of skeletal class III malocclusion in patients with significant improvement in profile appearance.

El objetivo de este estudio fue investigar los cambios morfológicos de la maloclusión clase esquelética III, en la dentición mixta, con actividades combinadas de protracción de la fuerza ligera. Se seleccionaron aleatoriamente 30 casos de ortodoncia en pacientes de ortodoncia de la Universidad Médica de Shanxi (edades: 6-10 años) a partir de cefalogramas laterales, utilizando el tipo de dispositivo de pretracción de vaciado maxilar oral, de acuerdo con la condición de la dentición maxilar para seleccionar las actividades correspondientes del dispositivo de expansión móvil, cada lado con fuerza de alrededor de 150-200 g, requiriendo que los pacientes los utilizaran de 10 a 12 horas al día. El dispositivo debía ser retirado después de alcanzar la oclusión normal. Se midió el perfil cefalométrico de correlación de las radiografías laterales craneales, antes y después del tratamiento ortodóncico. Se observó mejoramiento en todos los pacientes con maloclusión de clase esquelética. Las mediciones SNA, ANB, APtm, MP-SN, ANS-Me / N-Me aumentaron, el avance y la reconstrucción maxilar fueron los cambios más significativos; la mandíbula giró en el sentido de las agujas del reloj, se observó un aumento de la inclinación labial de los dientes anteriores. Fue reducida la inclinación anterior del diente inferior, el ángulo nasolabial disminuyó y en general mejoró significativamente la apariencia. Las actividades combinadas de protrusión de la fuerza radiante pueden llevar a una mejora signficativa en el perfil de pacientes con dentición mixta de maloclusión clase III.

Opções de tratamento ortodôntico compensatório da classe III sem exodontias de premolares / Treatment options of compensatory orthodontic treatment without premolar extractions

O tratamento ortodôntico, em pacientes adultos com padrão esquelético apresentando pequena discrepância, pode ser realizado com a camuflagem ortodôntica, por meio das compensações dentárias. Essas compensações, muitas vezes, são consideradas como fatores de risco para a saúde periodontal, principalmente, quando associadas à movimentos de inclinação dos incisivos, tanto para lingual como para vestibular. A finalidade do presente artigo foi apresentar, através de dois de casos clínicos, duas opções diferentes de tratamento compensatório para a Classe III. A primeira com o emprego de bráquetes autoligáveis do Sistema Damon, com prescrição individualizada para os arcos dentários superior e inferior, além dos elásticos intermaxilares de Classe III. Essa modalidade tem sua indicação na correção dos problemas dentários com suave discrepância esquelética entre as bases ósseas, corrigindo os problemas oclusais sem grandes sequelas para os dentes e tecidos de suporte, devido ao torque diferenciado dos bráquetes. A segunda opção é a movimentação sagital dos dentes inferiores para distal por meio de ancoragem esquelética com miniplacas de titânio. Esses dispositivos de ancoragem temporária (DATs) oferecem uma estável e efetiva ancoragem para a movimentação ortodôntica no tratamento da Classe III.(AU)

Orthodontic treatment, in adult patients with a skeletal pattern presenting a small discrepancy, can be performed with orthodontic camouflage by dental compensations. These compensations are many times considered as risk factors for periodontal health, especially when associated with incisor inclination, both lingual and buccal. The aim of this paper was to present, through two clinical cases, two different options for compensatory Class III treatment. The first one with the use of self-ligating brackets (Damon System), with individualized prescriptions for upper and lower dental arches, in addition to Class III intermaxillary elastics. This modality has its indication in the correction of dental problems with mild skeletal discrepancy between bone bases, correcting the occlusal problems without major sequelae for teeth and supporting tissues, due to brackets different torque. The second option is retracting the whole lower dentition through skeletal anchorage with titanium miniplates. These temporary anchoring devices (TADs) provide a stable and effective anchorage for orthodontic movement in Class III treatment.(AU)

Manejo del paciente con apiñamiento severo y mordida cruzada posterior bilateral con expansor maxilar tipo Hyrax

Las causas de las discrepancias transversales del maxilar superior pueden ser genéticas o ambientales. Se presenta un paciente de 17 años y 7 meses de edad. En su análisis clínico y radiográfico se diagnosticó como: Clase I esquelética, hiperdivergente, clase II molar y canina bilateral, mordida cruzada posterior bilateral, apiñamiento severo superior e inferior, órgano dental 22 cruzado. El tratamiento consistió de la fase de expansión maxilar y alineación, apertura de espacio para el 22, nivelación, detallado y retención. La aparatología utilizada brackets prescripción Roth ,022 x ,028, expansor maxilar tipo Hyrax, bandas en los molares 6's superiores, tubos bondeables en 6's y 7`s superiores e inferiores, open coil de Niti. La retención a cargo de circunferencial superior e inferior y fijo de 13-23 y 33-43, tiempo de tratamiento activo 1 año y 11 meses.

Causes of transverse discrepancies of the maxilla can be genetic or environmental. We present a patient of 17 years 7 months of age. In his clinical and radiographic analysis he was diagnosed as: Skeletal Class I, hyperdivergent, malocclusion class II bilateral molar and canine, bilateral posterior cross bite, severe upper and lower crowding, crossed dental organ. The treatment consisted of maxillary expansion and alignment, opening of space for 22, leveling, detailing and retention. The appliances used were brackets prescription Roth .022 x .028, maxillary expander type Hyrax, molar bands in the upper molars 6s, tubes in 6's and 7's upper and lower, open coil of Niti. The retention in charge of upper and lower circumferential retainer and a bonded retainer from 13- 23 and 33-43, time of active treatment 1 year 11 months.

Estudio morfométrico de la posición cráneo-cervical en pacientes con clases esqueletales II y III / Morphometric study of the skull-cervical position in patients with skeletal class II and III

La posición cráneo-cervical representa un factor importante en el diagnostico morfológico de discrepancias óseas, articulares y miofuncionales. En base a las diversas clases esqueletales se observan diferencias en la ubicación de puntos craneométricos que resultan determinantes en el diagnóstico del equilibrio ortostático del cráneo con la porción cervical de la columna vertebral. El objetivo de este estudio fue evaluar y comparar la posición cráneo-cervical en clases esqueletales II y III. Se recolectaron 114 radiografías laterales de cráneo, se analizaron y compararon los puntos craneométricos por medio de cefalometría con la Técnica de Rocabado. Los resultados muestran diferencias estadísticamente significativas en las posiciones craneales para cada clase esquelética tanto en distancias como rotación entre cráneo y porción cervical de la columna vertebral.

The skull-cervical position is an important factor in the morphological diagnosis of bone, joint and myofunctional discrepancies. Based on the various classes skeletal differences are observed in the locations that are critical points Craneometric diagnosis of orthostatic balance skull with the cervical portion of the spine. The aim of this study was to evaluate and compare Skull-cervical position in skeletal class II and III. Hundred fourteen lateral skull radiographs were collected, analyzed and compared the craniometric points through cephalometric with Rocabado technique. The results show a statistically significant difference in the positions for each skeletal cranial both class distances as rotation between the skull and cervical portion of the spine.