Photoanthropometric craniofacial parameters in individuals with osteogenesis imperfecta / Parámetros craneofaciales fotoantropométricos en personas con osteogénesis imperfecta

Background: This study aimed to evaluate facial photoanthropometric parameters in patients with OI.Material and Methods: We selected 20 Brazilian patients diagnosed with OI treated at the Extension Service forMinors in Need of Specialized Treatment of the Dentistry Course at the Federal University of Ceará (Fortaleza,Brazil), of both sexes, without age restriction, and able to understand and sign the informed consent form (ICF).As a control group, 38 non-syndromic Brazilian individuals, categorized as ASA I, able to understand and sign theICF, matched by sex, age, and Legan and Burstone facial profile were selected. The exclusion criteria were: previ-ous orthodontic treatment, craniofacial trauma and/or surgery, and the presence of any other systemic diseases.Photoanthropometric analysis of the 18 facial parameters proposed by Stengel-Rutkowski et al. (1984), previouslyestablished in the literature for craniofacial syndromes, were conducted. A single examiner digitally performedall effective and angular measurements with the CorelDRAWX7® software.Results: Horizontally shortened ears (p<0.001) but larger in height in relation to the face (p=0.012) were shownto be alterations belonging to individuals with OI.Conclusions: OI patients present distinct photoanthropometric parameters inherent in this condition.(AU)

Ganhos na via aérea superior com o MARPE ­ relato de caso / Enhancements in the upper airway space with MARPE ­ case report

A expansão rápida do palato assistida por mini-implantes (Mini-Implant Assisted Rapid Palatal Expansion - MARPE) é uma alternativa para tratar a deficiência esquelética transversal da maxila em pacientes adultos. O objetivo deste relato de caso foi verificar, por meio de Tomografia Computadorizada de Feixe Cônico (TCFC), os possíveis incrementos dimensionais e volumétricos na via aérea superior (VAS) após a utilização deste dispositivo em uma paciente adulta com má oclusão de Classe III e atresia maxilar transversa. Método: Foi realizado um protocolo de disjunção palatina com o dispositivo MARPE. TCFC foram obtidas antes (T0) e logo após finalizar o procedimento de expansão óssea transversa da maxila (T1). Resultados: Ocorreram mudanças dimensionais significativas da VAS em T1, incluindo um aumento na largura (77,5%) e comprimento do espaço retropalatal (51%), bem como no espaço retrolingual (33,7%). Além disso, observou-se um aumento no volume total (41%) e no volume da orofaringe (51,9%) da VAS. Conclusão: Este relato destaca ganhos dimensionais significativos na VAS após o uso do MARPE, enfatizando sua eficácia como abordagem terapêutica que contribui para aumentos importantes na VAS.(AU)

The Mini-Implant Assisted Rapid Palatal Expansion (MARPE) is an alternative for treating maxillary skeletal transverse deficiency in adult patients. The aim of this case report was to verify, through Cone Beam Computed Tomography (CBCT), the possible dimensional and volumetric increments in the upper airway (UA) after using this device in an adult patient with Class III malocclusion and transverse maxillary atresia. Method: A palatal disjunction protocol was performed with the MARPE device. CBCT scans were obtained before (T0) and immediately after completing the maxillary bone expansion procedure (T1). Results: Significant dimensional changes occurred in the UA at T1, including an increase in width (77.5%) and length (51%) of the retropalatal space, as well as in the length of the retrolingual space (33.7%). Additionally, there was an increase in total volume (41%) and oropharyngeal volume (51.9%) of the UA. Conclusion: This report highlights significant dimensional gains in the UA following MARPE use, emphasizing its efficacy as a therapeutic approach that contributes to significant increases in UA dimensions.(AU)

Condylar Position in the Treatment of Obstructive Sleep Apnea with a Mandibular Advancement Device: A Pilot Study.

Objective To evaluate, through a tomographic analysis, the positional changes of the condyle when using a mandibular advancement device (MAD) for the treatment of obstructive sleep apnea (OSA), and to assess if the condylar positions influence OSA polysomnographic patterns. Materials and Methods Ten OSA patients underwent treatment with an MAD, and polysomnographic and tomographic examinations were performed before therapy (T0) and after MAD placement (T1). Results By comparing the T0 and T1 measurements, we observed advancement and extrusion of the condyles in all patients ( p < 0.001), as well as a decrease in the apnea-hypopnea index (AHI) ( p < 0.001), increases in the mean ( p = 0.001) and minimum ( p < 0.001) oxyhemoglobin saturation, and a significant correlation between the anterior displacement of the right ( p = 0.003) and left ( p = 0.015) condyles. Discussion Condylar advancement was directly correlated with OSA improvement: the greater the advancement, the better the AHI.

Utilização do PowerScope para potencializar o tratamento da Classe II com Invisalign / Use of PowerScope to enhance Class II treatment with Invisalign

Resumo Corrigir a relação molar de Classe II em um paciente adulto não é uma tarefa fácil. E com os alinhadores ortodônticos isso torna-se ainda mais difícil. Os alinhadores têm dificuldade na sua correção, principalmente porque sua eficácia depende do uso de elásticos e, muitas vezes, os pacientes não colaboram o suficiente. Há casos em que o paciente deveria ser tratado com cirurgia ortognática, mas o paciente não aceita ser submetido a ela. Então, podemos tratá-lo de forma compensatória utilizando um propulsor mandibular, como o PowerScope. Este artigo descreve três maneiras de incorporar o PowerScope no tratamento da Classe II com o Invisalign. São descritos os desenhos híbrido, simplificado e complexo, cada um ilustrado por um caso clínico. Desta forma, pode-se concluir que o PowerScope pode ser um grande aliado no tratamento de casos complexos de Classe II junto aos alinhadores Invisalign. A abordagem é muito promissora, mas ainda necessita de alguns ajustes (AU)

Abstract Correcting a Class II molar relationship in an adult patient is not an easy task. And with orthodontic aligners this becomes even more difficult. Aligners have difficulties in Class II correction, mainly because their effectiveness depends on the use of elastics, and patients often do not cooperate enough. There are cases in which patients should be treated with orthognathic surgery, but they do not accept the surgery. So, we can treat them compensatory using a Class II corrector, like the PowerScope. This article describes three ways to incorporate PowerScope into Class II treatment with Invisalign. The designs are described as hybrid, simplified, complex and each one is illustrated by a clinical case. In this way, it can be concluded that PowerScope can be a great ally in the treatment of complex Class II cases with Invisalign aligners. The approach is very promising, but still needs some adjustments (AU)

Automatic multi-anatomical skull structure segmentation of cone-beam computed tomography scans using 3D UNETR.

The segmentation of medical and dental images is a fundamental step in automated clinical decision support systems. It supports the entire clinical workflow from diagnosis, therapy planning, intervention, and follow-up. In this paper, we propose a novel tool to accurately process a full-face segmentation in about 5 minutes that would otherwise require an average of 7h of manual work by experienced clinicians. This work focuses on the integration of the state-of-the-art UNEt TRansformers (UNETR) of the Medical Open Network for Artificial Intelligence (MONAI) framework. We trained and tested our models using 618 de-identified Cone-Beam Computed Tomography (CBCT) volumetric images of the head acquired with several parameters from different centers for a generalized clinical application. Our results on a 5-fold cross-validation showed high accuracy and robustness with a Dice score up to 0.962±0.02. Our code is available on our public GitHub repository.

Avaliação do padrão craniofacial de indivíduos do nordeste brasileiro portadores de apneia obstrutiva do sono ­ estudo cefalométrico / Assessment of craniofacial pattern from northeast Brazil individuals with obstructive sleep apnea ­ cephalometric study

Resumo A identificação de padrões craniofaciais associados à Apneia Obstrutiva do Sono (AOS) continua a despertar interesse na medida em que os predisponentes anatômicos podem divergir entre grupos populacionais. O objetivo do estudo foi identificar o padrão craniofacial e as principais características cefalométricas de indivíduos brasileiros com AOS nascidos no estado do Ceará ­ Nordeste do Brasil. Materiais e Métodos: Foram triados 50 voluntários cearenses com diagnóstico polissonográfico de AOS, os quais se submeteram à avaliação clínica, polissonográfica e cefalométrica. O grupo controle foi composto por 25 indivíduos cearenses adultos com oclusão dentária normal, sem relatos de sinais e/ou sintomas relacionados à AOS. Resultados: O grupo com AOS apresentou alterações nas estruturas anatômicas esqueletais, principalmente, um posicionamento inferior do osso hioide (p=0.001) e retrusão mandibular (p=0.012). Alterações também foram observadas nas dimensões dos tecidos moles faríngeos, principalmente, aumento no comprimento (p=0.001) e largura do palato mole (p=0.001), com diminuição do espaço aéreo póstero-superior (p=0.001). Apenas as variáveis cefalométricas SNA (posição anteroposterior da maxila) ­ (p=0.739) e EAP (espaço aéreo faríngeo inferior) ­ (p=0.268) não apresentaram diferenças entre os grupos. Conclusão: Grandezas cefalométricas representativas do posicionamento de estruturas esqueléticas e das dimensões de tecidos moles faríngeos se mostraram significativamente diferentes, quando um grupo de indivíduos com AOS foi comparado à indivíduos de um grupo controle. (AU)

Abstract The identification of craniofacial patterns associated to the Obstructive Sleep Apnea (OSA) continues to arise interest, especially since anatomical predisposing factors differ from group to group. The aim of this study was to identify the craniofacial patterns and cephalometric characteristics in Brazilian individuals with OSA born in Ceará ­ Northeast Brazil. Materials and Methods: fifty OSA volunteers diagnosed with a polysomnography were selected. The control group consisted of 25 adults from Ceará with normal dental occlusion and without reports of OSA signs or symptoms. All participants were submitted to clinical, polysomnographic, and cephalometric evaluation. Results: Individuals diagnosed with OSA showed alterations in skeletal anatomical structure, mainly a lower positioning of hyoid bone (p=0.001) and mandibular retrusion (p=0.012). Alterations have also been observed in the pharyngeal soft tissue dimensions, mainly an increase in soft palate length (p=0.001) and width (p=0.001) causing a reduction in posterosuperior airway (p=0.001). Only the cephalometric variables SNA (anteroposterior position of the maxilla) ­ (p=0.739) and EAP (inferior pharyngeal airspace) ­ (p=0.268) did not present differences between the groups. Conclusion: Cephalometric measurements representative of the positioning of skeletal structures and the dimensions of pharyngeal soft tissues were significantly different when a group of subjects with OSA was compared to subjects of a control group.(AU)

Avaliação tomográfica da via aérea orofaríngea após tratamento ortocirúrgico em paciente padrão II ­ relato de caso / Tomographic assessment of the oropharyngeal airway after orthosurgical treatment in class II patient ­ case report

Resumo O avanço cirúrgico maxilomandibular é uma alternativa de tratamento eficaz em pacientes com desarmonias esqueléticas anteroposteriores e essa abordagem terapêutica tem repercussões sobre a via aérea superior em indivíduos com padrão esquelético de Classe II. O presente estudo tem como objetivo relatar o tratamento ortodôntico-cirúrgico de um paciente com má oclusão esquelética de Classe II e avaliar as mudanças volumétricas da via aérea superior através de Tomografia Computadorizada de Feixe Cônico (TCFC). Métodos: Realizou-se o tratamento ortodôntico pré-cirúrgico e tratamento cirúrgico para avanço maxilo-mandibular, impacção da maxila e mentoplastia. Obtiveram-se imagens tridimensionais por TCFC nos períodos pré-operatório e pós-operatório (3 meses) da cirurgia. Resultados: Mudanças significativas em medidas de área e volume da orofaringe no pós-operatório foram identificadas. Observou-se um aumento de 56% no volume da via aérea superior e de 150% na área de mínima secção transversal. Conclusão: O presente estudo evidenciou ganhos dimensionais importantes na via aérea superior após o procedimento ortodôntico-cirúrgico instituído para o caso (AUU)

Abstract The maxillomandibular surgical advancement is an effective treatment alternative in patients with anteroposterior skeletal disharmonies and this therapeutic approach has repercussions on the upper airway of individuals with a Class II skeletal pattern. The present study aims to report the orthodontic-surgical treatment of a patient with Class II skeletal malocclusion and to evaluate the volumetric changes of the upper airway using Cone Beam Computed Tomography (CBCT). Methods: Pre-surgical orthodontic treatment and surgical treatment for maxillomandibular advancement, maxillary impaction, and mentoplasty were performed. Three-dimensional CBCT images were obtained preoperatively and postoperatively (3 months) after surgery. Results: Significant changes in postoperative oropharyngeal area and volume measurements were identified. An increase of 56% in the volume of the upper airway and of 150% in the minimum cross-sectional area was observed. Conclusion: The present study showed important dimensional gains in the upper airway after the orthodontic-surgical procedure set up for the case (AU)

A retrospective study of the influence of obesity on polysomnography and cephalometric parameters in males with obstructive sleep apnea.

OBJECTIVE: Evaluate the influence of obesity on the polysomnographic and cephalometric parameters in obstructive sleep apnea (OSA). METHODS: Fifty records of male patients with OSA, containing information on dental, medical, polysomnographic, and cephalometric exams were selected. The degree of obesity was based on Body Mass Index (BMI). Group I comprised normal or overweight individuals (BMI ≤ 29.9 kg/m2), whereas Group II consisted of obese individuals (BMI ≥ 29.9 kg/m2). RESULTS: BMI significantly correlated with apnea and hypopnea index (p < 0.0005), minimal oxyhemoglobin saturation (p < 0.0005), and two cephalometric variables (soft palate length, p = 0.01 and width, p = 0.01). Group II showed a significant correlation with the position of the hyoid bone (p = 0.02). Soft palate length and width significantly differed between groups (p = 0.014; 0.016). CONCLUSION: Obese males present wider and longer soft palate dimensions, and patients with a greater BMI present a more inferiorly positioned hyoid bone.

Defining dysmorphic facial features in congenital Zika syndrome.

Congenital Zika syndrome (CZS) constitutes a recently identified malformation caused by Zika virus infection during pregnancy. Limited data is available to date on the facial dysmorphic features of these patients. This study evaluated the facial dysmorphisms of children with CZS, compared with clinically healthy children, using clinical examination and standardized photographic images. Sixty-three children with CZS (9.70 ± 3.2 months-age), and 31 Controls (8.67 ± 6.2 months-age) joined the study. Seven out of 15 indices differed between groups: midfacial height (MFH)/horizontal facial reference (HFR) (p = .0003), interalar distance/HFR (p = .0027), nasal root depth/MFH (p = .0030), posterior nasal length/MFH (p = .0002), vertical position of the ear/MFH (p <.0001), ear length/MFH (p = .0005), chin height/total facial height (CH/TFH) (p <.0001). A CH/TFH of 0.229 showed 93.9% sensitivity and 80.6% specificity in diagnosing CZS. Children with CZS had broad, short faces, decreased intercanthal distance, short posterior nasal length, prominent nasal root, broad nasal wings, and high-set and long ears. Increased chin height index provided the most accurate diagnostic potential.

Distalização dos dentes inferiores para o tratamento da má oclusão de Classe III com o auxílio de dispositivos de ancoragem temporária ­ relato de caso / Distalization of lower teeth for the treatment of Class III malocclusion with the aid of temporary anchorage devices ­ case report

Resumo Este artigo descreve o tratamento ortodôntico de uma paciente jovem de 20 anos com má oclusão de Classe III. O plano de tratamento consistia em distalizar ambos os quadrantes posteriores inferiores para corrigir a má oclusão de Classe III. Além disso os objetivos do tratamento também incluíam a correção da mordida cruzada posterior e do apinhamento ântero- -inferior. Dois mini-implantes foram posicionados entre os segundos pré-molares e primeiros molares inferiores com o intuito de serem utilizados como ancoragem indireta. Molas espirais abertas foram utilizadas para a distalização, além do auxílio de elásticos de Classe III. O período total de tratamento foi de 24 meses. Ao final do tratamento, uma excelente oclusão foi obtida na paciente, juntamente com uma melhora no seu perfil facial. (AU)

Abstract This article describes the orthodontic treatment of a 20-year-old female patient with Class III malocclusion. The treatment plan consisted of distalizing both lower posterior quadrants to correct Class III malocclusion. In addition, treatment goals also included correction of posterior crossbite and anteroinferior crowding. Two mini-implants were placed between the second premolars and mandibular first molars in order to be used as indirect anchorage. Open spiral springs were used for distalization, in addition to the aid of Class III elastics. The total treatment period was 24 months. At the end of the treatment, an excellent occlusion was achieved in the patient along with an improvement in her facial profile (AU)

COVID-19 and dental sleep medicine: risks, precautions and patient guidance.

COVID-19 is the offcial name for the disease caused by SARS-CoV-2, which has become a pandemic, infecting more than 5 million people worldwide. Transmission occurs by inhaling droplets generated when an infected person coughs, sneezes or exhales, or by touching contaminated surfaces and then rubbing their hands over their eyes, nose or mouth. Some infected people become seriously ill, while others have no symptoms, but even though they are asymptomatic, they can still transmit the virus. As vaccines and effective medications do not yet exist, the only way to handle the devastating consequences of the pandemic is prevention. Quality of sleep is essential for the immune system to be prepared to receive, fight and restore itself after a viral infection. Therefore, patients with obstructive sleep apnea (OSA) should continue treatment, and only suspend or change the therapeutic modality under the guidance of a sleep physician. In the era of COVID-19, due to the high probability of contamination promoted by CPAP, the mandibular repositioning device has been considered as the first choice for patients with OSA. However, as the dental approach is at high risk of contamination, due to the proximity of the dental surgeon to the patient, it is essential that the professional who works in this field knows the risks to which they are exposed. Precautions must be adopted and patients should be guided in order to control and use of their intraoral devices.

Miniscope-Herbst digital / Digital miniscope-Herbst

O aparelho de Herbst tem sido amplamente utilizado no mundo todo para tratar a má oclusão de Classe II com retrognatismo mandibular. Entretanto, no Brasil tem sido pouco utilizado. O custo do aparelho, a curva de aprendizado acentuada para manipular o aparelho e a falta de laboratórios com conhecimento para confeccioná-lo adequadamente têm contribuído para este fato. Sendo assim, o objetivo deste artigo é mostrar o fluxo digital para a confecção do aparelho MiniScope Herbst e demonstrar as facilidades de trabalhar desta forma. Após a confecção e instalação do aparelho aqui mostrado, pode-se concluir que a utilização de modelos digitais, juntamente com o sistema MiniScope e a soldagem a laser, tornou a confecção do aparelho de Herbst muito mais previsível e confiável. Espera-se assim contribuir para a facilidade de utilização clínica do aparelho e para diminuir o número de intercorrências. (AU)

The Herbst appliance has been widely used worldwide to treat Class II malocclusion with mandibular retrognathism. However, in Brazil it has been little used. The cost of the device, the steep learning curve for handling the device, and the lack of laboratories with the knowledge to properly manufacture it have contributed to this fact. Therefore, the objective of this article is to show the digital flow for the manufacture of the MiniScope Herbst device and demonstrate the facilities of working in this way. After making and installing the device shown here, it can be concluded that the use of digital models, together with the MiniScope system and laser welding made the fabrication of the Herbst appliance much more predictable and reliable. Thus, it is expected to contribute to the ease of clinical use of the device and to reduce the number of complications (AU)

Utilização clínica da trava alternativa do powerScope ­ descrição passa a passo / Clinical use of alternative powerScope attachment nut - step by step description

Desde a sua introdução em 2014 o aparelho PowerScope tem passado por algumas modificações visando aprimorar e facilitar a sua utilização clínica. Este artigo descreve a última inovação no aparelho, que consiste em uma trava alternativa. Com esta nova trava, o conceito muda um pouco porque se instala a trava fora da boca do paciente e não diretamente na sua boca como fazíamos com as duas primeiras gerações da trava. A trava alternativa é mais uma opção de uso do PowerScope. Cabe ao ortodontista decidir qual opção se ajusta melhor a sua forma de trabalho: continuar com as travas 2 (de 2015); utilizar as travas alternativas nos arcos superior e inferior; utilizar as travas alternativas no arco superior e as travas 2 no arco inferior (AU)

Since its introduction in 2014, the PowerScope device has undergone some modifications to improve and facilitate its clinical use. This article describes the latest innovation in the device, which consists of an alternative attachment nut. With this new nut, the concept changes a little because we are going to install the nut outside the patient's mouth and not directly in his mouth as we did with the first two generations of the nut. The alternative attachment nut is another option for using the PowerScope. It is up to the orthodontist to decide which option best fits his way of working: continue with nut 2 (from 2015); use the alternative nut on the upper and lower arches; use alternate nut on the upper arch and nut 2 on the lower arch.(AU)

Cone beam computed tomography in assessment on pharynx effects of orthopedic-surgical treatment - a review of the literature.

The cone beam computed tomography (CBCT) image provides clear differentiation of soft tissues from empty spaces. This paper presents a literature review to evaluate the effects of orthopedic and surgical treatment on the pharyngeal dimension by CBCT. It was concluded that treatments involving dentofacial orthopedics and orthognathic surgery have been related with an increase in the upper airway volume. Standardized capturing of tomographic images and more controlled and randomized studies are necessary.

Dental alterations on panoramic radiographs of patients with osteogenesis imperfecta in relation to clinical diagnosis, severity, and bisphosphonate regimen aspects: a STROBE-compliant case-control study.

OBJECTIVE: This study aimed to assess the prevalence of dental findings on panoramic radiographs (PRs) of patients with osteogenesis imperfecta (OI) and correlate these results with epidemiologic and medical data. STUDY DESIGN: A case-control study was conducted with 24 patients with OI and 48 sex- and age-matched controls. Demographic, clinical, and bisphosphonate regimen-related data were recorded. The outcome variables were the presence or absence of dental alterations in PRs. Mann-Whitney U test, Pearson's χ2 test, and multinomial logistic regression analysis (95% confidence interval) were used (significance level of 5%). RESULTS: OI type 4 demonstrated a high prevalence (62.5%), followed by type 1 (37.5%). With regard to prevalence associated with severity, the moderate form was the most prevalent (P = .028). The mean time of intravenous pamidronate regimen was 6.6 ± 4.4 years. Dentinogenesis imperfecta was observed in 75% of patients with OI, and this group showed a high prevalence of dental abnormalities in comparison with controls (P < .05). Bisphosphonate therapy was associated with ectopic teeth (P = .007) and tooth impaction (P = .033). Pulp obliteration was significant with bisphosphonate treatment over a period of 7 years (P = .026). CONCLUSIONS: This study found a significant prevalence of dental alterations in patients with OI, and certain alterations were associated with bisphosphonate therapy, indicating its influence on the dentin-related physiopathology.

Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review.

INTRODUCTION: Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. OBJECTIVE: This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. METHODS: An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. RESULTS: A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. CONCLUSION: The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.

Severe obstructive sleep apnea treatment with mandibular advancement device: A case report.

Mandibular advancement device (MAD) has been described as an alternative treatment to the severe obstructive sleep apnea (OSA), once it is not as effective as the continuous positive airway pressure therapy (CPAP) in reducing the apnea and hypopnea index (AHI). The objective of this study is to report a case using a MAD in a CPAP-intolerant patient suffering from severe OSA. Polysomnography exams were performed before and after treatment. Five months after fitting and titrating the MAD, the AHI was reduced from 80.5 events/hour to 14.6 events/hour and the minimum oxyhemoglobin saturation (SpO2) increased from 46% to 83%. A two-year assessment of therapy revealed an AHI of 8 events/hour and SpO2 of 85%.

Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review

ABSTRACT Introduction: Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. Objective: This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. Methods: An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. Results: A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. Conclusion: The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.

RESUMO Introdução: efeitos colaterais oclusais e o desenvolvimento de dor e/ou disfunção do complexo temporomandibular podem levar à baixa adesão ou ao abandono do tratamento do ronco e da apneia obstrutiva do sono com aparelhos de avanço mandibular. Objetivo: fornecer uma revisão abrangente da literatura sobre os efeitos colaterais craniofaciais do tratamento do ronco e da apneia obstrutiva do sono com aparelhos de avanço mandibular. Métodos: foram realizadas buscas eletrônicas sistematicamente no PubMed e na Biblioteca Virtual em Saúde até outubro de 2016. Foram incluídos apenas Ensaios Controlados Randomizados, com o objetivo primário de mensurar objetivamente os efeitos colaterais no complexo craniofacial associados ao uso de aparelhos de avanço mandibular no tratamento do ronco e da apneia obstrutiva do sono. Os pacientes estudados deveriam ter 20 anos de idade ou mais. A avaliação do risco de viés dos trabalhos selecionados seguiu as recomendações do The Cochrane Risk of Bias. Resultados: no total, 62 artigos completos foram avaliados em relação à elegibilidade. Após o processo de revisão, apenas 6 atenderam aos critérios de inclusão. Todos os estudos foram julgados como tendo alto risco de viés. Os efeitos colaterais mais frequentemente encontrados foram de natureza dentária e incluíram uma diminuição do overjet e do overbite. O risco de desenvolvimento de dor ou disfunção do complexo temporomandibular pareceu limitado na avaliação de longo prazo do uso do aparelho de avanço mandibular. Conclusão: as evidências disponíveis são limitadas e sugerem que o tratamento do ronco e da apneia obstrutiva do sono com aparelhos de avanço mandibular resulta em alterações craniofaciais predominantemente dentárias, especialmente nas avaliações de longo prazo. Considerando-se que a apneia obstrutiva do sono é crônica e que os aparelho intrabucais se constituem em uma forma de tratamento contínuo e por tempo indefinido, é necessário um acompanhamento individualizado para monitorar possíveis efeitos colaterais no complexo craniofacial. Também é importante informar aos pacientes sobre esses possíveis efeitos, especialmente àqueles nos quais são esperadas maiores alterações oclusais ou nos quais elas sejam desfavoráveis. Ainda são necessárias avaliações de longo prazo dos efeitos colaterais do tratamento com aparelhos intrabucais, com amostras maiores e mais homogêneas.

Correlação entre variáveis cefalométricas e polissonográficas em indivíduos com apneia / Correlation between cephalometric and polysomnographic variables in individuals with obstructive sleep apnea

Indivíduos portadores de Apneia Obstrutiva do Sono (AOS) podem apresentar alterações do esqueleto craniofacial e do espaço aéreo faríngeo que influenciam no padrão de sono e na gravidade da AOS. A cefalometria radiográfica é um exame de imagem rotineiramente usado pelos ortodontistas que permite a avaliação da anatomia craniocervicofacial, incluindo o espaço aéreo faríngeo. Objetivo: avaliar se os componentes anatômicos cefalométricos têm alguma correlação com parâmetros polissonográficos de indivíduos com AOS. Materiais e Métodos: A casuística deste estudo foi composta de 50 indivíduos com diagnóstico polissonográfico de AOS moderada e grave. Todos os voluntários foram submetidos à avaliação polissonográfica de noite inteira e a avaliação cefalométrica em norma lateral. Resultados: Foram encontradas correlações significantes entre a variável polissonográfica Índice de Apneia e Hipopneia (IAH) e as grandezas cefalométricas correspondentes à largura do palato mole (p<0,01) e a distância do hióide à terceira vértebra cervical (p<0,01). A variável polissonográfica Saturação Mínima de Oxihemoglobina (SpO2) apresentou correlação significante com as duas variáveis cefalométricas acima citadas e também com a variável correspondente ao comprimento do palato mole (p<0,05). Conclusão: Algumas variáveis cefalométricas demonstraram correlação com parâmetros polissonográficos, mas não se deve afirmar que a cefalometria possa ser usada como preditora da gravidade da AOS. (AU)

Individuals with Obstructive Sleep Apnea (OSA) may present changes in the craniofacial skeleton and pharyngeal airway space that have an influence in sleep pattern and OSA severity. Radiographic cephalometry is an imaging test routinely used by orthodontists that allows assessment of the craniocervical facial anatomy including the pharyngeal airway spa-ce. Objective: To evaluate if the cephalometric anatomical components have any correlation with polysomnographic parameters of individuals with OSA. Materials and Methods: The study sample consisted of 50 individuals with polysomnographic diagnosis of moderate and severe OSA. All volunteers underwent a full-night polysomnographic evaluation and a lateral cephalometric radiographic examination. Results: Significant correlations were found between the polysomnographic variable Apnea and Hypopnea Index (AHI) and the cephalometric variablecorresponding to the width of the soft palate (p <0.01) and the distance from the hyoid to the third cervical vertebra (p <0.01). The polysomnographic variable Oxyhemoglobin Minimal Saturation (SpO2) showed a significant correlation with the two cephalometric variables mentioned above, as well as with the variable corresponding to the length of the soft palate (p<0,05). Conclusion: Some cephalometric variables correlate with polysomnographic parameters, but we cannot say that cephalometry can be used as a predictor of OSA severity. (AU)

Reabilitação ortodôntica e protética na agenesia de incisivos laterais superiores com prótese adesiva de fibra de reforço associada ao cerômero – relato de caso / Orthodontic and prosthetic rehabilitation in agenesis of lateral incisors with adhesive reinforcement fiber denture associated with ceromer – case report

O tratamento reabilitador de agenesia de incisivos laterais superiores envolve, quase sempre, uma abordagem interdisciplinar. O presente artigo propõe-se a expor uma solução terapêutica conservadora, através de ortodontia e reabilitação protética, em um caso de agenesia congênita bilateral de incisivos laterais permanentes. A escolha da melhor opção terapêutica, o domínio da mecânica ortodôntica e a utilização da técnica reabilitadora adequada influenciaram na qualidade do resultado do tratamento.

The rehabilitation treatment of agenesis of upper lateral incisors almost always involves an interdisciplinary approach. This article aims to describe a conservative therapeutic solution through orthodontics and prosthetic rehabilitation in a case of congenital bilateral agenesis of permanent lateral incisors. The choice of the best therapeutic option, the handling of orth-odontic mechanics and the use of appropriate rehabilitative technique influenced the quality of treatment outcome.