Comparative analysis of the anterior and posterior length and deflection angle of the cranial base, in individuals with facial Pattern I, II and III.

OBJECTIVE: This study evaluated the variations in the anterior cranial base (S-N), posterior cranial base (S-Ba) and deflection of the cranial base (SNBa) among three different facial patterns (Pattern I, II and III). METHOD: A sample of 60 lateral cephalometric radiographs of Brazilian Caucasian patients, both genders, between 8 and 17 years of age was selected. The sample was divided into 3 groups (Pattern I, II and III) of 20 individuals each. The inclusion criteria for each group were the ANB angle, Wits appraisal and the facial profile angle (G'.Sn.Pg'). To compare the mean values obtained from (SNBa, S-N, S-Ba) each group measures, the ANOVA test and Scheffé's Post-Hoc test were applied. RESULTS AND CONCLUSIONS: There was no statistically significant difference for the deflection angle of the cranial base among the different facial patterns (Patterns I, II and III). There was no significant difference for the measures of the anterior and posterior cranial base between the facial Patterns I and II. The mean values for S-Ba were lower in facial Pattern III with statistically significant difference. The mean values of S-N in the facial Pattern III were also reduced, but without showing statistically significant difference. This trend of lower values in the cranial base measurements would explain the maxillary deficiency and/or mandibular prognathism features that characterize the facial Pattern III.

Comparative analysis of the anterior and posterior length and deflection angle of the cranial base, in individuals with facial Pattern I, II and III

OBJECTIVE: This study evaluated the variations in the anterior cranial base (S-N), posterior cranial base (S-Ba) and deflection of the cranial base (SNBa) among three different facial patterns (Pattern I, II and III). METHOD: A sample of 60 lateral cephalometric radiographs of Brazilian Caucasian patients, both genders, between 8 and 17 years of age was selected. The sample was divided into 3 groups (Pattern I, II and III) of 20 individuals each. The inclusion criteria for each group were the ANB angle, Wits appraisal and the facial profile angle (G'.Sn.Pg'). To compare the mean values obtained from (SNBa, S-N, S-Ba) each group measures, the ANOVA test and Scheffé's Post-Hoc test were applied. RESULTS AND CONCLUSIONS: There was no statistically significant difference for the deflection angle of the cranial base among the different facial patterns (Patterns I, II and III). There was no significant difference for the measures of the anterior and posterior cranial base between the facial Patterns I and II. The mean values for S-Ba were lower in facial Pattern III with statistically significant difference. The mean values of S-N in the facial Pattern III were also reduced, but without showing statistically significant difference. This trend of lower values in the cranial base measurements would explain the maxillary deficiency and/or mandibular prognathism features that characterize the facial Pattern III.

OBJETIVO: o presente estudo avaliou as variações da base craniana anterior (S-N), base craniana posterior (S-Ba), e ângulo de deflexão da base do crânio (SNBa) entre três diferentes padrões faciais (Padrão I, II e III). MÉTODOS: selecionou-se uma amostra de 60 telerradiografias em norma lateral de pacientes brasileiros leucodermas, de ambos os sexos, com idades entre 8 anos e 17 anos. A amostra foi dividida em três grupos (Padrão I, II e III), sendo cada grupo constituído de 20 indivíduos. Os critérios de seleção dos indivíduos para cada grupo basearam-se nos valores de ANB, Wits e ângulo do contorno facial (Gl.Sn.Pg'). Para observar se houve diferença nos valores médios de SNBa, S-N e S-Ba entre os diferentes grupos, utilizou-se a Análise de Variância One Way - ANOVA, seguida de testes post-hoc de Scheffé. RESULTADOS E CONCLUSÕES: não houve diferença estatisticamente significativa na deflexão da base do crânio entre os diferentes padrões faciais (Padrão I, II e III). Também não houve diferença significativa nos valores da base anterior e posterior do crânio entre o Padrão I e o Padrão II. Os valores médios de S-Ba apresentaram-se reduzidos no Padrão III, com diferença estatisticamente significativa. Os valores médios de S-N também se apresentaram reduzidos no Padrão III, embora sem diferença estatisticamente significativa. Essa tendência a valores reduzidos da base do crânio poderia explicar a deficiência maxilar e/ou prognatismo mandibular, características que podem estar presentes no Padrão III.

Accuracy of linear measurements and visibility of the mandibular canal of cone-beam computed tomography images with different voxel sizes: an in vitro study.

BACKGROUND: The major use of cone-beam computed tomography (CBCT) is in implant planning. Although CBCT has been shown to be a reliable tool for measurements, we were unable to find studies comparing the differences between images acquired using different voxel sizes for implant planning. The aims of the present in vitro study are to verify the accuracy of linear measurements and to analyze the visibility of the mandibular canal on CBCT images obtained using different voxel sizes. METHODS: Twelve dry human hemimandibles were scanned using voxel sizes of 0.2, 0.3, and 0.4 mm, and 108 transversal CBCT images were generated, on which two examiners performed 648 linear measurements and evaluated the visibility of the mandibular canal. RESULTS: The global mean ± SD error between measurements on images and direct measurements was 0.23 ± 0.20 mm. CBCT measurements underestimated direct measurements in 390 cases (60.2%). All measurement errors found were <1 mm. There was a statistically significant difference (P = 0.0001 and P = 0.0028) between the two examiners only when measuring the width in two posterior sites. There was a statistically significant difference (P = 0.0242) between voxel sizes only for one of the examiners, for a measurement of height. It was possible to visualize the mandibular canal in all of the 108 images evaluated. CONCLUSIONS: Transversal CBCT images are adequate for linear measurements in the posterior region of the mandible and provide adequate visualization of the mandibular canal using voxel sizes of 0.2, 0.3, or 0.4 mm. A voxel of 0.3 mm is a good compromise between image quality and low radiation dose.

Tratamento da má oclusão de classe II, divisão 1, com AEB conjugado / Treatment of Class II, division 1, maloclusion using a maxillary splint appliance

O aparelho de extrabucal conjugado, introduzido na literatura por Thurow, constitui uma das abordagens para o tratamento da má oclusão de Classe II, divisão 1. O objetivo do presente trabalho consiste em salientar aspectos do diagnóstico que irão possibilitar a indicação desse aparelho na dentadura mista, bem como observar ops efeitos esqueléticos, dentários e tegumentares induzidos.

Incremental effects of facemask therapy associated with intermaxillary mechanics.

OBJECTIVES: To determine the dentofacial changes in children with skeletal Class III malocclusions treated with maxillary expansion, external maxillary protraction and intermaxillary traction. METHODS: Fifteen Class III patients in either the deciduous or the mixed dentition (Mean age: 7.6 years; SD: 1.9 years) were used. The children were treated with a modified Haas expander, a modified lingual arch, intermaxillary elastics and facemask for nine months. Lateral cephalometric radiographs were taken at the beginning of treatment (T1) and at 3-month intervals (T2, T3, T4). RESULTS: Most significant sagittal skeletal modifications occurred in the first three months of treatment. During the first three months of treatment the upper and lower incisors tipped lingually and the face height increased. Towards the end of treatment the upper incisors proclined and the upper lip became more protrusive. CONCLUSION: The therapy corrected the horizontal skeletal and arch discrepancies and improved the positions of the lips.

Comparative study of two skeletal maturation evaluation indexes / Estudo comparativo de dois índices de estimativa da maturação esquelética

Purpose: The present work consists of a comparative study of two indexes of skeletal maturation: the carpal index (SMI) and the vertebral index (CVMI) and verification of the reliability of the vertebral index in the determination of the stages of the skeletal maturation. Methods: Radiographies from the dental records of treated patients from Universidade do Sul de Santa Catarina (UNISUL) were used. The sample was composed of 158 radiographies comprising seventy-nine carpal and seventy-nine lateral cephalometric radiographies of patients of both genders between six and eighteen of age. The carpal radiographies were analyzed using Martins' method and the lateral cephalometric, according to Baccetti, Franchi and McNamara Jr. Results: The Spearman's correlation test results showed a significant correlation coefficient of 0.616 between SMI and CVMI and the Pearson's test, of 0.698 for both genders (P<0.0001). The correlation between the indexes and the chronological age was 0.775 for SMI using Spearman's test, and 0.974 using Pearson's correlation test. For the CVMI, Spearman's correlation was 0.563 and Pearson's was 0.717, showing that there is a statistically significant correlation. Conclusion: The SMI is the safest and most trustworthy method to evaluate the skeletal maturation, although the CVMI can be used as a substitute method when there is conversance with the morphologic alterations of the vertebrae and when the carpal radiography is not available in the patient's orthodontic records.

Objetivo: Comparar o índice de maturação esquelética carpal (IMC) e o índice vertebral (IMV) e verificar a confiabilidade do IMV na determinação desta maturação. Metodologia: Utilizou-se radiografias dos prontuários da disciplina de Ortodontia da UNISUL. A amostra foi composta por 158 radiografias, sendo 79 carpais e 79 cefalométricas em norma lateral, de pacientes com idades variando entre 6 e 18 anos, de ambos os sexos. Para a determinação do IMC utilizou-se o método de Martins e para o IMV, o de Baccetti, Franchi e McNamara Jr. Resultados: Os testes de correlação de Spearman e Pearson mostraram um índice entre IMC e IMV de 0,616 e 0,698, respectivamente, correlação estatisticamente significante para ambos os sexos (P<0,0001). A correlação de Spearman e de Pearson entre o IMC e a idade cronológica foi de 0,775 e 0,974, respectivamente. Já entre o IMV e a idade cronológica foi de 0,563 e 0,717, respectivamente, uma correlação também estatisticamente significante. Conclusão: O IMC é o método mais seguro e confiável de avaliação da maturação esquelética, porém o IMV pode ser usado como método substituto quando houver familiaridade com as alterações morfológicas das vértebras e quando a radiografia carpal não estiver disponível na documentação ortodôntica.

The relationship between nasopharyngeal tonsil size and laboratory markers in children infected with HIV / Relação entre tamanho da tonsila faríngea e marcadores laboratoriais em crianças infectadas por HIV

Purpose: The enlargement of nasopharyngeal tonsils, which leads to nasal obstruction and subsequent mouth breathing, can be caused by the presence of HIV. The aim of this research was to study nasopharyngeal tonsil sizes in HIV-infected children ranging from 6 to 13 years and to relate these findings to CD4+ T-cell counts and viral loads. Methods: Sixty children with HIV (mean age: 9 years and 8 months), infected by vertical transmission, had the sizes of their nasopharynx measured using lateral cephalometric radiographs, specifically focusing on the anatomical areas occupied by the nasopharyngeal tonsils. The children’s medical records were analyzed to assess information about TCD4+ lymphocyte count (%) and viral loads (log10). Results: The mean value for the nasopharyngeal tonsil size percentage was 70.37%±14.07%.All of the children showed moderate or accentuated hypertrophy of nasopharyngeal tonsils. The average percentage of CD4+ T-cells among the 60 HIV-infected children was 35.01%±10.76%, whereas the mean value for the viral load was 3.35±1.08 log10. Conclusion: There was no association between the size percentages of the nasopharyngeal tonsils (calculated against overall nasopharynx sizes) and CD4+ T-cell percentage (r=-0.0136; P=0.298) or the viral load log10 (r=-0.033; P=0.805).

Objetivo: A presença do HIV na tonsila faríngea pode causar seu aumento de volume, ocasionando obstrução nasal e, consequentemente, respiração bucal. O objetivo deste trabalho foi avaliar o tamanho da tonsila faríngea em crianças infectadas pelo HIV por transmissão vertical, de 6 a 13 anos de idade, relacionando-a com a contagem de células T-CD4+ e carga viral (log10).Metodologia: Sessenta crianças HIV positivo (idade média: 9 anos e 8 meses), infectadas por transmissão vertical, tiveram o tamanho da tonsila faríngea mensurado na radiografia cefalométrica lateral da face. Os prontuários das crianças foram analisados para buscar os dados de contagem de linfócitos T-CD4+ (%) e carga viral (log10). Resultados: A média do tamanho da tonsila faríngea foi de 70,37%±14,07%. As crianças apresentaram hipertrofia da tonsila faríngea considerada moderada ou acentuada. A porcentagem média de linfócitos T-CD4+ nas 60 crianças foi de 35,01%±10,76% e a média da carga viral foi de 3,35±1,08 log10. Conclusão: Não foi comprovada relação entre o tamanho da tonsila faríngea com a porcentagem de linfócitos T-CD4+ (r=-0,0136; P=0,298) e com a carga viral (r=-0,033; P=0,805).

Tração reversa da maxila associada à mecânica intermaxilar no tratamento precoce do Padrão III: relato de caso / Maxillary protaction associated with intermaxillary mechanics for Pattern III early treatment: case report

Dentre as modalidades de tratamento precoce do Padrão III, a tração reversa associada à expansão rápida da maxila constitui a abordagem mais popular e estudada na literatura ortodôntica, produzindo os melhores resultados no menor período de tempo. Os aparelhos comumente usados para promover a protração maxilar envolvem um dispositivo intrabucal capaz de provocar a disjunção da maxila e uma máscara facial ou mentoneira modificada, capazes de aplicar forças ortopédicas sobre a maxila e estimular seu crescimento em direção anterior. Relatos recentemente publicados envolvem o uso de variados aparelhos intra e extra-bucais, implantes, platôs fixos de acrílico, ou outras abordagens que visam maximizar o efeito ortopédico da tração reversa da maxila. O foco do presente artigo consiste em avaliar as mudanças ocorridas no complexo dentofacial em uma paciente jovem com Padrão III tratada com tração reversa da maxila associada à mecânica intermaxilar.

A comparative study of the breathing pattern and amount of nasopharynx obstruction by the pharyngeal tonsil in HIV infected and non infected children.

AIM: the goal of the present investigation was to study the association between breathing pattern and pharyngeal tonsil size in 122 children (60 HIV infected and 62 without such infection). MATERIAL AND METHODS: The children were analyzed as to their breathing pattern, nasal flow and pharyngeal tonsil obstruction seen in side cephalometric x-rays, by means of a computerized analysis. RESULTS: The pattern that most occurred in both groups was the mixed type. Most of the children presented oral or mixed type breathing and there was no association between the type of breathing and HIV presence (p=0.091). Nasal flow was mainly medium in both groups. Children without prior history of HIV infection had medium to large nasal flow and most of the HIV-infected children had medium nasal airflow. There was a positive association between nasal flow and HIV infection (p<0.0001). The average percentage of nasopharynx obstruction by the pharyngeal tonsil was high in both groups, and there was no statistically significance difference between them. Children from both groups had a moderate or large size of pharyngeal tonsil, and there was no association between tonsil size and HIV (p=0.21).

Estudo comparativo do padrão de respiração e a porcentagem de ocupação da nasofaringe pela tonsila faríngea em crianças com ou sem história de infecção pelo HIV / A comparative study of the breathing pattern and amount of nasopharynx obstruction by the pharyngeal tonsil in hiv infected and non infected children

OBJETIVO: o objetivo deste estudo foi estudar a associação entre o padrão de respiração e o tamanho da tonsila faríngea em 122 crianças (60 infectadas pelo HIV e 62 sem infecção). MATERIAL E MÉTODO: As crianças foram analisadas quanto ao padrão de respiração, fluxo nasal e ocupação da tonsila faríngea em radiografias cefalométricas de perfil, através de uma análise computadorizada. RESULTADOS: O padrão de respiração de maior ocorrência nos dois grupos foi o tipo misto. A maioria das crianças apresentou tipo de respiração bucal ou mista, não havendo associação entre o tipo de respiração e presença do HIV (p=0,091). O fluxo nasal mostrou predomínio do fluxo médio nos dois grupos. As crianças sem história de infecção pelo HIV apresentaram fluxo nasal de médio a grande e a maioria das crianças infectadas pelo HIV apresentou de pouco a médio fluxo nasal de ar, havendo uma associação positiva entre o fluxo nasal e a infecção pelo HIV (p<0,0001). A porcentagem média de ocupação da tonsila faríngea foi alta nos dois grupos, não havendo diferença estatisticamente significante entre eles. As crianças dos dois grupos apresentaram aumento moderado ou acentuado do tamanho da tonsila faríngea, não havendo associação entre o tamanho da tonsila faríngea e presença do HIV (p=0,201).

AIM: the goal of the present investigation was to study the association between breathing pattern and pharyngeal tonsil size in 122 children (60 HIV infected and 62 without such infection). MATERIAL AND METHODS: The children were analyzed as to their breathing pattern, nasal flow and pharyngeal tonsil obstruction seen in side cephalometric x-rays, by means of a computerized analysis. RESULTS: The pattern that most occurred in both groups was the mixed type. Most of the children presented oral or mixed type breathing and there was no association between the type of breathing and HIV presence (p=0.091). Nasal flow was mainly medium in both groups. Children without prior history of HIV infection had medium to large nasal flow and most of the HIV-infected children had medium nasal airflow. There was a positive association between nasal flow and HIV infection (p<0.0001). The average percentage of nasopharynx obstruction by the pharyngeal tonsil was high in both groups, and there was no statistically significance difference between them. Children from both groups had a moderate or large size of pharyngeal tonsil, and there was no association between tonsil size and HIV (p=0.21).