Proposal for the Modification of the Method to Evaluate the Midpalatal Suture Maturation Status / Proposta de Modificação do Método para Avaliação do Status da Sutura Palatina Mediana

The objective of present research was to propose a new definition for the midpalatal suture (MPS) maturational stages through reevaluation of intermediate stages B, C and D. The sample was composed by 158 cone-beam computed tomography (CBCT) of individuals between 11 and 20 years of age (±15.4 years, 86 females and 71 males), divided into two groups: 74 individuals aged 11-15 years and 84 individuals aged 16-20 years. The CBCT scans were applied to evaluate midpalatal suture maturation status and comprised stages previously classified as B (29), C (92) and D (37). Each axial image was subdivided into six parts in the anteroposterior direction, and each portion was classified according to MPS maturational evaluation methodology. New definitions of stages were proposed. The reliability of the method was tested by two examiners and the intra- and inter-examiner concordances were defined for each evaluation through weighted kappa coefficients and 95% confidence intervals. The chi-square test was used to compare the groups. In all statistical tests, a significance level of 5% was adopted. Two new maturational stages were defined: sub-stage C- and sub-stage C+, with prevalence of 12% and 8.9%, respectively, in 11 to 20-year-olds. The redefinition and validation of the maturational stages of MPS, considering the sub-stages C- and C+, may allow to elucidate the difference in the prognosis of Rapid Maxillary Expansion among individuals aged 11 to 20 years. This data should be confirmed through a clinical study.(AU)

O objetivo da presente pesquisa foi propor uma nova definição para os estágios maturacionais da sutura palatina média (MPS) por meio da reavaliação dos estágios intermediários B, C e D. A amostra foi composta por 158 tomografias computadorizadas de feixe cônico (TCFC) de indivíduos entre 11 e 20 anos de idade (±15,4 anos, 86 do sexo feminino e 71 do sexo masculino), divididos em dois grupos: 74 indivíduos de 11 a 15 anos e 84 indivíduos de 16 a 20 anos. Os exames de TCFC foram aplicados para avaliar o estado de maturação da sutura palatina média e compreenderam os estágios previamente classificados como B (29), C (92) e D (37). Cada imagem axial foi subdividida em seis partes no sentido anteroposterior, e cada porção foi classificada de acordo com a metodologia de avaliação maturacional MPS. Novas definições de estágios foram propostas. A confiabilidade do método foi testada por dois examinadores e as concordâncias intra e interexaminadores foram definidas para cada avaliação por meio de coeficientes kappa ponderados e intervalos de confiança de 95%. O teste do qui-quadrado foi utilizado para comparar os grupos. Em todos os testes estatísticos adotou-se o nível de significância de 5%. Dois novos estágios maturacionais foram definidos: subestágio C- e subestágio C+, com prevalência de 12% e 8,9%, respectivamente, em jovens de 11 a 20 anos. A redefinição e validação dos estágios maturacionais da MPS, considerando os subestágios C- e C+, podem permitir elucidar a diferença no prognóstico da Expansão Rápida da Maxila entre indivíduos de 11 a 20 anos. Esses dados devem ser confirmados por meio de um estudo clínico.(AU)

Compensation in Class III Malocclusions: Analysis of Tooth Crown Inclination on Digital Dental Casts / Compensação da Má Oclusão de Classe III: Análise da Inclinação das Coroas dos Dentes em Modelos Digitais

The objective of this study was to evaluate the tooth crown inclination in maxillary and mandibular arches in Class III malocclusion individuals, to identify the presence and magnitude of compensation. The study was conducted on 46 plaster casts of individuals with Class III malocclusion, of both genders (25 males and 21 females), with mean age 21 years and 1 month, with indication for compensatory orthodontic treatment. The dental casts models were scanned and the tooth crown inclinations were measured and compared with standard values by the independent t test. All tests considered a significance level of 5% (p<0.05). According to the results there was extensive variation in tooth inclination in Class III malocclusions. Values distribution for incisors highlighted the significant concentration of maxillary incisors in the area of positive values, compared with a very expressive concentration of mandibular incisors in the area of negative values. Compared with normal standards, in Class III malocclusions, the maxillary posterior teeth exhibited smaller palatal inclination than normal, while the mandibular incisors and second molars presented greater lingual inclination. It was concluded that the analysis of inclinations of all crowns of both dental arches in Class III malocclusions, compared with normal standards, evidenced the presence of natural compensation for maxillary posterior teeth, with reduced palatal inclination, as well as increased lingual inclination in mandibular incisors. The parameters of compensation naturally present in Class III malocclusions described, especially in lower incisors, would help clinicians when compensatory treatment is considered. (AU)

O objetivo deste estudo foi avaliar a inclinação das coroas dentárias nas arcadas superior e inferior em indivíduos com má oclusão de Classe III, para identificar a presença e a magnitude da compensação. O estudo foi realizado em 46 modelos de gesso de indivíduos com má oclusão de Classe III, de ambos os sexos (25 homens e 21 mulheres), com média de idade de 21 anos e 1 mês, com indicação de tratamento ortodôntico compensatório. Os modelos de gesso foram digitalizados e as inclinações da coroa dos dentes foram medidas e comparadas com os valores de normalidade pelo teste t independente. Todos os testes estatísticos adotaram um nível de significância de 5% (p <0,05). De acordo com os resultados, houve grande variação na inclinação dentária nas más oclusões de Classe III. A distribuição dos valores para os incisivos destacou a concentração significativa de incisivos superiores na área de valores positivos, em comparação com uma concentração muito expressiva de incisivos inferiores na área de valores negativos. Comparados aos padrões de normalidade, nas más oclusões de Classe III, os dentes posteriores superiores exibiram inclinação palatina menor que o normal, enquanto os incisivos e segundos molares inferiores apresentaram inclinação lingual maior. Concluiu-se que a análise das inclinações de todas as coroas de ambas as arcadas dentárias nas más oclusões de Classe III, comparadas aos padrões de normalidade, evidenciou a presença de compensação natural para os dentes posteriores superiores, com diminuição da inclinação palatina, bem como aumento da inclinação lingual dos incisivos inferiores. Os parâmetros de compensação naturalmente presentes nas más oclusões de Classe III descritos, especialmente nos incisivos inferiores, podem auxiliar o clínico quando o tratamento compensatório é considerado. (AU)

Pretreatment dentoskeletal comparison between individuals treated with extractions in the 1970s and in the new millennium.

OBJECTIVE: This retrospective study aimed to compare the occlusal and dentoskeletal initial features of patients treated with four first premolar extractions in the 1970s and after 2000. MATERIALS AND METHODS: Group 70' was composed by 30 subjects with Class I malocclusion (mean age of 12.8 years, 10 male, 20 female) treated in the 1970s with four first premolar extractions and comprehensive orthodontic treatment. Group NM comprised 30 subjects with Class I malocclusion (mean age of 13.4 years, 13 male, 17 female) treated in the new millennium, similarly to Group 70'. Initial dental models and lateral cephalograms were digitized and measured using OrthoAnalyzerTM 3D software and Dolphin Imaging 11.0 software, respectively. Initial occlusal and dentoskeletal features were analyzed and compared. Intergroup comparison was performed using t tests (p < 0.05). Holm-Bonferroni correction for multiple comparison was applied. RESULTS: Group NM showed significantly greater maxillary and mandibular effective lengths and greater maxillary and mandibular incisor protrusion in comparison with Group 70'. Group NM presented a significantly greater lower anterior facial height. Group NM also showed significantly smaller nasolabial angle and protruded inferior lip. CONCLUSION: Patients with Class I malocclusion treated with four first premolar extractions in the new millennium present a greater degree of dental and labial protrusion, increased lower anterior facial height, and more acute nasolabial angle compared with patients treated similarly in the 1970s. Greater dental and labial protrusion determines first premolar extractions in the new millennium. CLINICAL RELEVANCE: Despite the decrease of tooth extraction frequency, four first premolar extractions may be justified in cases with severe dental and skeletal protrusions.

Reliability and reproducibility of the method of assessment of midpalatal suture maturation: A tomographic study.

OBJECTIVES: To assess reliability and reproducibility of the individual assessment of midpalatal suture maturation in computed tomography among orthodontists and radiologists for potential diagnosis application. MATERIALS AND METHODS: Sixty axial slices from cone-beam computed tomography and multi-slice CT scans of patients aged between 11 and 21 years old (33 females and 27 males) were selected. For the investigation of reliability and reproducibility of the method, two groups of examiners were established. The first group consisted of 11 orthodontists and the second consisted of 10 radiologists. Each group examined the images and performed individual assessment of the midpalatal suture maturation method twice within an interval of 21 days. During the first and second analyses, the sequence of images was randomized to reduce potential bias. Weighted Cohen's kappa was performed to assess inter- and intra-examiners' agreement. The percentage of perfect agreement and the number of stages apart for each disagreement were calculated. The significance level was P < .05. RESULTS: The overall inter-examiner agreement was satisfactory in the first (kappaw: 0.37) and the second (kappaw: 0.34) analyses. Intra-examiner agreement outcomes were similar between orthodontists (kappaw: 0.44) and radiologists (kappaw: 0.41). The percentage of perfect agreement was 43.2%. CONCLUSIONS: The method for individual assessment of midpalatal suture maturation revealed potential reliability and reproducibility. However, the agreement rate observed in the present study was not high enough for a method designed for routine clinical applications.

Tomographic evaluation of the maturation stage of the midpalatal suture in postadolescents.

INTRODUCTION: In this study, we aimed at evaluating the maturation stage of the midpalatal suture based on its morphology, using cone-beam computed tomography images in young postadolescents. METHODS: The sample comprised 112 patients, 68 female and 44 male, aged 16 to 20 years, consecutively selected from 2 private orthodontic clinics. They had cone-beam computed tomography images in their initial orthodontic files, requested for orthodontic planning purposes. These images were exported to the Invivo 5 program (Anatomage, San Jose, Calif), where axial sections were obtained from the midpalatal suture for morphologic evaluation. Two previously calibrated examiners interpreted the images to establish the stage of sutural maturation of each patient according to its morphologic characteristics in 5 maturational stages (A, B, C, D, and E). The kappa coefficient was applied for intraexaminer and interexaminer agreements, and their values were 0.87 and 0.89, respectively. RESULTS: The maturational stages most often observed in this study were C, D, and E, (91.9%). In males, stage C was present in 52.3%; for females this prevalence was 39.7%. CONCLUSIONS: The high prevalence of stage C in this age group may justify a clinical study to confirm the good prognosis for rapid maxillary expansion in postadolescents.

Facial profile esthetics in operated children with bilateral cleft lip and palate

ABSTRACT Objective: The aim of this study was to evaluate the facial profile esthetics of rehabilitated children with complete bilateral cleft lip and palate (BCLP), comparing the judgment of professionals related and not related to cleft rehabilitation and laypersons. Methods: Thirty children in the mixed dentition (24 male; 6 female) with a mean age of 7.8 years were evaluated using facial profile photographs by 25 examiners: 5 orthodontists and 5 plastic surgeons with experience in cleft care, 5 orthodontists and 5 plastic surgeons without experience in oral cleft rehabilitation and 5 graduated laymen. Their facial profiles were classified into esthetically unpleasant (grade 1 to 3), esthetically acceptable (grade 4 to 6), and esthetically pleasant (grade 7 to 9). Intraexaminer and interexaminer errors were evaluated using Spearman correlation coefficient and Kendall's test, respectively. Inter-rater differences were analyzed using Friedman test and Student-Newman-Keuls test for multiple comparisons. Results: Orthodontists dealing with oral clefts rehabilitation considered the majority of the sample as esthetically pleasant. Plastic surgeons of the cleft team and laypersons classified most of the sample as esthetically acceptable. Most of the orthodontists and plastic surgeons not related to cleft care evaluated the facial profile as esthetically unpleasant. The structures associated to unpleasant profiles were the nose, the midface and the upper lip. Conclusions: The facial profile of children with BCLP was classified as esthetically acceptable by laypersons. Professionals related to cleft rehabilitation were more lenient and those not related to cleft care were stricter to facial esthetics than laypersons.

RESUMO Objetivo: o objetivo desse estudo foi avaliar a estética do perfil facial de crianças com fissura labiopalatina completa bilateral (FLCB) operadas, comparando o julgamento de leigos e de profissionais relacionados e não relacionados à reabilitação de fissuras. Métodos: fotografias do perfil facial de trinta crianças na dentadura mista (24 do sexo masculino e 6 do sexo feminino), com idade média de 7,8 anos, foram avaliadas por 25 examinadores: 5 ortodontistas e 5 cirurgiões plásticos com experiência em fissuras, 5 ortodontistas e 5 cirurgiões plásticos sem experiência na reabilitação de fissuras, e 5 leigos com formação superior. Os perfis faciais foram classificados como esteticamente desagradável (grau 1 a 3), esteticamente aceitável (grau 4 a 6) e esteticamente agradável (grau 7 a 9). Para verificar a concordância intraexaminadores e interexaminadores, foram utilizados o Coeficiente de Correlação de Spearman e o Coeficiente de Concordância de Kendall, respectivamente. Para comparação entre as categorias de acordo com os escores atribuídos, foram aplicados o teste de Friedman e o teste de Student-Newman-Keuls, para comparações múltiplas. Resultados: os ortodontistas que lidam com reabilitação de fissuras labiopalatinas consideraram a maioria da amostra como esteticamente agradável. Cirurgiões plásticos com experiência em fissuras e leigos classificaram a maioria da amostra como esteticamente aceitável. Grande parte dos ortodontistas e cirurgiões plásticos sem experiência na reabilitação de fissuras classificou o perfil facial como esteticamente desagradável. As estruturas associadas aos perfis desagradáveis foram o nariz, o terço médio da face e o lábio superior. Conclusões: o perfil facial de crianças com FLCB foi classificado como esteticamente aceitável pelos leigos; já os profissionais relacionados à reabilitação de fissuras foram mais complacentes, em comparação aos profissionais sem experiência na reabilitação de fissuras, que, por sua vez, foram mais rigorosos quanto à estética facial do que os leigos.

Midpalatal suture maturation in 11- to 15-year-olds: A cone-beam computed tomographic study.

INTRODUCTION: We used cone-beam computed tomography to evaluate the maturation stages of the midpalatal sutures in children aged 11 to 15 years old. Maxillary expansion is successful for most patients in this age group, so we sought to identify the status of suture maturation in these subjects to use as a comparison for the prognosis of rapid maxillary expansion in older patients. METHODS: Tomographic images in axial sections of the midpalatal sutures from 84 children (40 boys, 44 girls; ages, 11-15 years) were classified using a scale denoting the maturation stage of the midpalatal suture (A, B, C, D, and E). The chi-square test was applied to evaluate suture stages by sex and age groups. RESULTS: Stage A was observed in only one 11-year-old girl. Stage B was present at all ages but was more prevalent in those less than 13 years of age. Stage C was the most prevalent in all evaluated ages. Stages D and E showed low prevalence rates. There were higher prevalences of the early stages of maturation in boys. CONCLUSIONS: The results of this study, which showed dominant prevalence of stage C, suggest that conventional, nonsurgical rapid maxillary expansion performed in patients over 15 years old is justified by a satisfactory prognosis when assessment of the sutural status indicates stage C.

Evaluation of facial attractiveness in black people according to the subjective facial analysis criteria.

OBJECTIVE: The objective of this study was to evaluate the facial attractiveness in 30 black individuals, according to the Subjective Facial Analysis criteria. METHODS: Frontal and profile view photographs of 30 black individuals were evaluated for facial attractiveness and classified as esthetically unpleasant, acceptable, or pleasant by 50 evaluators: the 30 individuals from the sample, 10 orthodontists, and 10 laymen. Besides assessing the facial attractiveness, the evaluators had to identify the structures responsible for the classification as unpleasant and pleasant. Intraexaminer agreement was assessed by using Spearman's correlation, correlation within each category using Kendall concordance coefficient, and correlation between the 3 categories using chi-square test and proportions. RESULTS: Most of the frontal (53. 5%) and profile view (54. 9%) photographs were classified as esthetically acceptable. The structures most identified as esthetically unpleasant were the mouth, lips, and face, in the frontal view; and nose and chin in the profile view. The structures most identified as esthetically pleasant were harmony, face, and mouth, in the frontal view; and harmony and nose in the profile view. The ratings by the examiners in the sample and laymen groups showed statistically significant correlation in both views. The orthodontists agreed with the laymen on the evaluation of the frontal view and disagreed on profile view, especially regarding whether the images were esthetically unpleasant or acceptable. CONCLUSIONS: Based on these results, the evaluation of facial attractiveness according to the Subjective Facial Analysis criteria proved to be applicable and to have a subjective influence; therefore, it is suggested that the patient's opinion regarding the facial esthetics should be considered in orthodontic treatmentplanning.

Subjective facial analysis and its correlation with dental relationships

ABSTRACT INTRODUCTION: Subjective facial analysis is a diagnostic method that provides morphological analysis of the face. Thus, the aim of the present study was to compare the facial and dental diagnoses and investigate their relationship. METHODS: This sample consisted of 151 children (7 to 13 years old), without previous orthodontic treatment, analyzed by an orthodontist. Standardized extraoral and intraoral photographs were taken for the subjective facial classification according to Facial Pattern classification and occlusal analyses. It has been researched the occurrence of different Facial Patterns, the relationship between Facial Pattern classification in frontal and profile views, the relationship between Facial Patterns and Angle classification, and between anterior open bite and Long Face Pattern. RESULTS: Facial Pattern I was verified in 64.24% of the children, Pattern II in 21.29%, Pattern III in 6.62%, Long Face Pattern in 5.96% and Short Face Pattern in 1.99%. A substantial strength of agreement of approximately 84% between frontal and profile classification of Facial Pattern was observed (Kappa = 0.69). Agreement between the Angle classification and the Facial Pattern was seen in approximately 63% of the cases (Kappa = 0.27). Long Face Pattern did not present more open bite prevalence. CONCLUSION: Facial Patterns I and II were the most prevalent in children and the less prevalent was the Short Face Pattern. A significant concordance was observed between profile and frontal subjective facial analysis. There was slight concordance between the Facial Pattern and the sagittal dental relationships. The anterior open bite (AOB) was not significantly prevalent in any Facial Pattern.

RESUMO INTRODUÇÃO: a análise facial subjetiva é um método diagnóstico que privilegia a avaliação morfológica da face; assim, o principal objetivo do presente trabalho foi comparar os diagnósticos faciais e dentários e investigar a correlação entre eles. MÉTODOS: a amostra consistiu de 151 crianças (7 a 13 anos de idade), sem nenhum tratamento ortodôntico prévio, analisadas por um ortodontista. Foram realizadas fotografias padronizadas extrabucais e intrabucais, para a classificação subjetiva dos Padrões Faciais e das relações dentárias segundo a classificação de Angle. Investigou-se a ocorrência de diferentes tipos de Padrões Faciais, em vistas frontal e de perfil; a relação entre os Padrões Faciais e as relações dentárias de Classe e, também, entre a má oclusão de mordida aberta anterior e o Padrão Face Longa. RESULTADOS: o Padrão Facial I (PF I) esteve presente em 64,24% das crianças; o PF II, em 21,29%; o PF III, em 6,62%; o PF Face Longa, em 5,96% e o PF Face Curta, em 1,99%. Observou-se concordância substancial entre a avaliação do PF na vista frontal e na de perfil, igual a 84% (Kappa = 0,69). Houve concordância entre a avaliação da relação dentária de Classe e do PF em 63% da amostra (Kappa = 0,27). O PF Face Longa não demonstrou maior prevalência da má oclusão de mordida aberta. CONCLUSÃO: os Padrões Faciais I e II foram os mais prevalentes em crianças, enquanto o menos prevalente foi o Padrão Face Curta. Verificou-se concordância significativa entre as análises faciais frontal e de perfil. Existe uma ligeira concordância entre o Padrão Facial e a relação sagital dentária. A mordida aberta anterior não se apresentou mais prevalente em nenhum tipo de Padrão Facial.

Root length and alveolar bone level of impacted canines and adjacent teeth after orthodontic traction: a long-term evaluation

Abstract Objective The aim of this retrospective study was to evaluate the long-term effects of orthodontic traction on root length and alveolar bone level in impacted canines and adjacent teeth. Material and Methods Sample consisted of 16 patients (nine males and seven females), mean initial age 11 years and 8 months presenting with unilaterally maxillary impacted canines, palatally displaced, treated with the same surgical and orthodontic approach. Teeth from the impacted-canine side were assigned as Group I (GI), and contralateral teeth as control, Group II (GII). The mean age of patients at the end of orthodontic treatment was 14 years and 2 months and the mean post-treatment time was 5 years and 11 months. Both contralateral erupted maxillary canines and adjacent teeth served as control. Root length and alveolar bone level (buccal and palatal) were evaluated on cone-beam computed tomography (CBCT) images. The comparison of root length and alveolar bone level changes between groups were assessed by applying paired t-test, at a significance level of 5% (p<0.05). Results There were no statistically significant differences in root length and buccal and palatal bone levels of canines and adjacent teeth among groups. Conclusions Impacted canine treatment by closed-eruption technique associated with canine crown perforation, has a minimal effect on root length and buccal and palatal alveolar bone level in both canine and adjacent teeth, demonstrating that this treatment protocol has a good long-term prognosis.

Evaluation of facial attractiveness in black people according to the subjective facial analysis criteria

ABSTRACT Objective: The objective of this study was to evaluate the facial attractiveness in 30 black individuals, according to the Subjective Facial Analysis criteria. Methods: Frontal and profile view photographs of 30 black individuals were evaluated for facial attractiveness and classified as esthetically unpleasant, acceptable, or pleasant by 50 evaluators: the 30 individuals from the sample, 10 orthodontists, and 10 laymen. Besides assessing the facial attractiveness, the evaluators had to identify the structures responsible for the classification as unpleasant and pleasant. Intraexaminer agreement was assessed by using Spearman's correlation, correlation within each category using Kendall concordance coefficient, and correlation between the 3 categories using chi-square test and proportions. Results: Most of the frontal (53. 5%) and profile view (54. 9%) photographs were classified as esthetically acceptable. The structures most identified as esthetically unpleasant were the mouth, lips, and face, in the frontal view; and nose and chin in the profile view. The structures most identified as esthetically pleasant were harmony, face, and mouth, in the frontal view; and harmony and nose in the profile view. The ratings by the examiners in the sample and laymen groups showed statistically significant correlation in both views. The orthodontists agreed with the laymen on the evaluation of the frontal view and disagreed on profile view, especially regarding whether the images were esthetically unpleasant or acceptable. Conclusions: Based on these results, the evaluation of facial attractiveness according to the Subjective Facial Analysis criteria proved to be applicable and to have a subjective influence; therefore, it is suggested that the patient's opinion regarding the facial esthetics should be considered in orthodontic treatmentplanning.

RESUMO Objetivo: avaliar, quanto à agradabilidade facial, uma amostra de 30 indivíduos negros, de acordo com os critérios da Análise Facial Subjetiva. Métodos: fotografias frontais e de perfil de 30 indivíduos negros foram avaliadas quanto à agradabilidade facial e classificadas como esteticamente desagradáveis, aceitáveis ou agradáveis, por 50 avaliadores, sendo: 30 indivíduos da amostra, 10 ortodontistas e 10 leigos. Além de avaliar a agradabilidade facial, os avaliadores tiveram que identificar as estruturas responsáveis pela classificação como desagradável ou agradável. A concordância intraexaminador foi avaliada por meio da correlação de Spearman. Já a correlação dentro de cada categoria foi analisada por meio do coeficiente de concordância de Kendall, e a correlação entre as três categorias foi estabelecida por meio dos testes qui-quadrado e de proporção. Resultados: a maioria das fotografias frontais (53,5%) e de perfil (54,9%) foi classificada como esteticamente aceitável. As estruturas mais identificadas como esteticamente desagradáveis foram: boca, lábios e rosto, na fotografia frontal; e nariz e queixo, na fotografia de perfil. As estruturas mais identificadas como esteticamente agradáveis foram: harmonia, rosto e boca, na fotografia de frente; e harmonia e nariz, na de perfil. As avaliações realizadas pelos examinadores nos grupos amostra e leigos mostraram uma correlação estatisticamente significativa em ambas as posições. Os ortodontistas concordaram com os leigos sobre a avaliação na perspectiva frontal e discordaram sobre a de perfil, especialmente no que diz respeito às imagens consideradas esteticamente desagradáveis ou aceitáveis. Conclusões: com base nesses resultados, a avaliação da agradabilidade facial, de acordo com critérios da Análise Facial Subjetiva, provou ser aplicável e ter uma influência subjetiva. Assim, sugere-se que a opinião do paciente sobre a estética facial seja considerada no planejamento do tratamento ortodôntico.

Analysis of reliability, accuracy, sensitivity and predictive value of a subjective method to classify facial pattern in adults

ABSTRACT Introduction: Craniofacial pattern diagnosis is vital in Orthodontics, as it influences decision-making regarding treatment options and prognosis. Capelozza Filho proposed a subjective method for facial classification comprising five patterns: I, II, III, Long Face and Short Face. Objective: To investigate the accuracy of a subjective classification method of facial patterns applied to adults. Methods: A sample consisting of 52 adults was used for this study. Frontal and lateral view photographs were taken with subjects at rest position, including frontal smile. Lateral cephalometric radiographs were organized in a PowerPoint® presentation and submitted to 20 raters. Method performance was assessed by examining reproducibility with Kappa test and calculating accuracy, sensitivity and positive predictive values, for which 70% was set as critical value. The gold standard of the classification was personally set by the author of the method. Results: Reproducibility was considered moderate (Kappa = 0.501); while accuracy, sensitivity and positive predictive values yielded similar results, but below 70%. Conclusions: The subjective method of facial classification employed in the present study still needs to have its morphological criteria improved in order to be used to discriminate the five facial patterns.

RESUMO Introdução: o diagnóstico do padrão craniofacial é fundamental em Ortodontia, visto que influencia tanto a decisão terapêutica quanto seu prognóstico. Capelozza Filho propôs um método subjetivo de classificação facial em cinco padrões: Padrão I, Padrão II, Padrão III, Face Longa e Face Curta. Objetivo: investigar o desempenho do método subjetivo de classificação do padrão facial, quando aplicado em adultos. Métodos: a amostra foi composta por 52 adultos de ambos os sexos. Fotografias frontal e lateral em repouso, frontal em sorriso e telerradiografia em norma lateral foram montadas em apresentação do PowerPoint® e levadas pessoalmente aos vinte examinadores. Para se avaliar o desempenho do método, foi analisada a reprodutibilidade por meio do teste Kappa e calculados os valores de acurácia, sensibilidade e valor preditivo positivo, para os quais adotou-se 70% como valor crítico. O padrão-ouro foi constituído pela classificação realizada pelo autor do método. Resultados: a reprodutibilidade foi considerada regular (Kappa 0,501) enquanto a acurácia, sensibilidade e valor preditivo positivo obtiveram resultados próximos; porém, abaixo de 70%. Conclusão: o método subjetivo de classificação facial precisa de aprimoramentos nos critérios morfológicos utilizados para discriminar os cinco padrões faciais.

Age-related changes in the Brazilian woman's smile.

The aim of this research was to evaluate age-related changes in the smile of Brazilian women. The sample consisted of 249 Brazilian women who had not undergone previous orthodontic treatment or facial surgery. They were divided into four groups, according to age: G1 (20-29), G2 (30-39), G3 (40-49) and G4 (50 or older). Standardized front view photographs were taken while smiling and at rest. Measurements were evaluated by ANOVA and post-hoc Tukey. The Chi-square test was applied for qualitative variables. Upper lip thickness at rest and exposure of upper incisors on smiling decreased with age. Most individuals (60.9%) exhibited a medium smile. High smiles were more often seen in G1 (45%) and less frequently in G4 (18.8%), whereas the opposite occurred with the low smile, i.e., G4 (21.9%) and G1 (6.7%). Variations among the groups were observed in the transverse exposure of the teeth on smiling. In G1 and G3, there was a balance between tooth exposures, so that the teeth were exposed as far as the premolars and/or molars. Most of the women (56.3%) in G2 exposed their teeth as far as the first molars on smiling, whereas most of those (40.6%) in G4 exposed their teeth only as far as the first premolars on smiling. As age increased, there was decreased exposure of the upper incisors, decreased upper lip thickness and lower exposure of teeth vertically and transversely.

Intrusão de molar como um ato ortodôntico isolado, permitido pelo uso de dispositivos de ancoragem transitórios / Molar tooth intrusion as a single orthodontic act by the use of temporary anchorage devices

Este relato de caso clínico mostra como é possível fazer a intrusão do molar superior isoladamente sem aparelhos fixos. Uma paciente de 42 anos, má-oclusão classe II (subdivisão direita) se apresentou com o dente 17 extruído e o antagonista sem espaço para restauração do implante dentário previamente colocado. Dois DATs (máximo de 15 Ncm) foram posicionados e unidos por uma corrente elástica. O grau de força variou progressivamente (50 g, 120 g e 150 g). A finalização da intrusão ocorreu após cinco meses, e o dente 17 foi esplintado ao dente 16 por alças metálicas 0,020". O uso dos mini-implantes como ancoragem para movimentos ortodônticos é uma terapia mais simples, capaz de corrigir o plano oclusal em molares superiores sem o desgaste dentário excessivo que levaria ao tratamento endodôntico e necessidade de mais uma restauração de cobertura total.

This case report demonstrates how to intrude the maxillary molar tooth without fixed orthodontic appliances. A 42 years-old female, class II malocclusion patient presented with extrusion at the tooth 17 and no restorative space for the an already placed dental implant at the position of 47. For this, two TADs (up to 15 Ncm torque) were installed and joined by an elastic chain. The force levels were progressively increased (50 g, 120 g, and 150 g). Five months later, the tooth 17 was in the correct position and was splinted together to the tooth 16 by 0.020" metallic loops. The use of dental mini-implants as anchorage for orthodontic movements is a more simple therapy, which can correct the occlusal plane of maxillary molars without excessive dental reduction avoiding the endodontic treatment and the need for an additional completecoverage restorative service.

Therapeutic expectations: Dentistry relies less on dental plaque as a major etiological factor. OR On the dental needs of young orthodontic patients (12-20 years old).

In Brazilian cities and states governed efficiently with wealth ethically administered, carious and periodontal diseases have prevalence rates similar to those found in socially developed European countries. This shift in reality, noticed over the last 15 years, reflects on changes in the etiological factors related to patients' major expectations and needs--especially young and orthodontic patients--which turn out to be a result of dental trauma, malocclusion, facial aspect, dental agenesis and iatrogenesis. Under such conditions, patients begin to appreciate the value of tooth position, color and shape, their smile and function: details become relevant. Carious and periodontal diseases remain an issue, not only from a preventive prospect, but also from a curative one. Nevertheless, it should be noted that changes and development are inevitable, and we should be prepared to contribute to the wellbeing of people, particularly regarding their novel needs and expectations.

Facial and occlusal esthetic improvements of an adult skeletal Class III malocclusion using surgical, orthodontic, and implant treatment.

The aim of this clinical report is to describe the complex treatment of an adult Class III malocclusion patient who was disappointed with the outcome of a previous oral rehabilitation. Interdisciplinary treatment planning was performed with a primary indication for implant removal because of marginal bone loss and gingival recession, followed by orthodontic and surgical procedures to correct the esthetics and skeletal malocclusion. The comprehensive treatment approach included: (1) implant removal in the area of the central incisors; (2) combined orthodontic decompensation with mesial displacement and forced extrusion of the lateral incisors; (3) extraction of the lateral incisors and placement of new implants corresponding to the central incisors, which received provisional crowns; (4) orthognathic surgery for maxillary advancement to improve occlusal and facial relationships; and finally, (5) orthodontic refinement followed by definitive prosthetic rehabilitation of the maxillary central incisors and reshaping of the adjacent teeth. At the three-year follow-up, clinical and radiographic examinations showed successful replacement of the central incisors and improved skeletal and esthetic appearances. Moreover, a Class II molar relationship was obtained with an ideal overbite, overjet, and intercuspation. In conclusion, we report the successful esthetic anterior rehabilitation of a complex case in which interdisciplinary treatment planning improved facial harmony, provided gingival architecture with sufficient width and thickness, and improved smile esthetics, resulting in enhanced patient comfort and satisfaction. This clinical case report might be useful to improve facial esthetics and occlusion in patients with dentoalveolar and skeletal defects.

Therapeutic expectations: Dentistry relies less on dental plaque as a major etiological factor OR On the dental needs of young orthodontic patients (12-20 years old)

In Brazilian cities and states governed efficiently with wealth ethically administered, carious and periodontal diseases have prevalence rates similar to those found in socially developed European countries. This shift in reality, noticed over the last 15 years, reflects on changes in the etiological factors related to patients' major expectations and needs - especially young and orthodontic patients - which turn out to be a result of dental trauma, malocclusion, facial aspect, dental agenesis and iatrogenesis. Under such conditions, patients begin to appreciate the value of tooth position, color and shape, their smile and function: details become relevant. Carious and periodontal diseases remain an issue, not only from a preventive prospect, but also from a curative one. Nevertheless, it should be noted that changes and development are inevitable, and we should be prepared to contribute to the wellbeing of people, particularly regarding their novel needs and expectations.

A cárie e a doença periodontal em cidades e estados brasileiros com gestão eficiente e ética dos recursos apresenta índices de prevalência semelhantes aos de países europeus mais desenvolvidos socialmente. Essa mudança de realidade, percebida ao longos dos últimos 15 anos, reflete na mudança dos agentes etiológicos relacionados às principais expectativas e necessidades dos pacientes - especialmente os jovens e ortodônticos -, as quais passam a ser decorrentes do traumatismo dentário, má oclusão, aspecto facial, agenesias dentárias, iatrogenias. Nessa nova condição, passam a valorizar a posição, cor e forma dos dentes, seu sorriso e suas funções: os detalhes passam a ser relevantes. Ainda devemos nos preocupar com a cárie e doença periodontal, inclusive nos seus aspectos curativos e não mais apenas preventivos, mas devemos perceber que as mudanças e evoluções são inevitáveis, e nos preparar para contribuir para o bem das pessoas quanto às suas novas necessidades e expectativas.

Aesthetic Implant Rehabilitation in Periodontally Compromised Patients: A Surgical and Prosthetic Rationale.

Two cases of aesthetic implant abutment rehabilitation in the maxillary anterior area in periodontally compromised patients following conventional periodontal therapy and tooth extractions are presented. For the two cases of anterior tooth loss due to advanced periodontal disease progression, atraumatic flapless extractions were performed followed by the placement of immediate implants and provisional restorations. For the first case, lithium disilicate cemented over the abutment was used to achieve excellent aesthetic results. In the second case, custom zirconia abutments were used as prosthetic components. The results at the 3-year follow-up showed absence of inflammation and/or infection on the peri-implantar tissue with satisfactory aesthetic and excellent biological and clinical results achieved with reduced treatment time and morbidity for both patients. Total absence of infection and frequent plaque control after implant placement are mandatory before selection of the abutment material. The planning of the final treatment as specified by the concept of comprehensive dental care is outlined, and the final outcome is discussed in relation to the literature.