Descriptive analysis of the cases published in the Align® Global Gallery.

INTRODUCTION: Social media enhanced access to information, making it easier to share dental treatments. OBJECTIVE: This study aimed to conduct a descriptive analysis of the clinical cases published on the Align® Global Gallery platform. MATERIAL AND METHODS: A retrospective cross-sectional study of 1,582 cases was conducted, data extracted referred to the following basic information: case number; patient's age; reported gender; Invisalign® package modality; treatment time; aligner exchange protocol; total number of aligners per arch; type of retainers, and inclusion of initial and final panoramic and cephalometric radiographs. RESULTS: The majority were young (mean age 24.6 years, SD = 11.6), female patients (69.1%) with Class I malocclusion (39.4%) and crowding (77.9%). Comprehensive treatment was common (66.5%), with an average treatment time of 18 months (SD = 8.56; 95% CI = 17.6-18.5), with the most frequently reported aligner exchange protocol being 7 days (49.5%), with an average of 50.6 aligners in the upper arch (SD = 26.9; 95% CI = 49.2-51.9), and 48.7 in the lower arch (SD = 26.1; 95% CI = 47.4-50.0). Arch expansion (66.9%) and interproximal reduction (59.7%) were common approaches, while extractions were rare (4.3%). In most cases, initial lateral cephalometric (80.4%) and panoramic (93.3%) radiographs were presented. However, the final radiograph count dropped, with lateral cephalometric at 69.2%, and panoramic at 82.2% of cases. CONCLUSION: Cases in the Align®Global Gallery mostly feature Class I patients with crowded teeth, treated with expansion and interproximal reduction. The absence of standardized information and post-treatment data restricts the applicability of these findings to broader Invisalign® treatment trends.

Estudo da anatomia do septo nasal e sua relação com a morfologia do complexo nasomaxilar / Study of the anatomy of the nasal septum and its relationship with the morphology of the nasomaxillary complex

O presente estudo teve como objetivo investigar a influência do desvio do septo nasal (DSN) na morfologia do complexo nasomaxilar quanto a confiabilidade e precisão na marcação de pontos craniofaciais bidimensionais (2D) e tridimensionais (3D) em imagens de tomografia computadorizada de feixe cônico (TCFC), verificação de assimetrias do complexo nasomaxilar em indivíduos com diferentes níveis de DSN em estágios de maturação esquelética distintos, e analisar a associação entre o grau de severidade do DSN e o grau de assimetria do complexo nasomaxilar. Este foi um estudo observacional retrospectivo que utilizou um total de 60 TCFC alocadas em 4 grupos (n = 15) de acordo com o grau de desvio septal e maturação esquelética (DSN <10°, desvio de septo nasal leve, e DSN >10°, desvio de septo nasal moderado a severo, ambos antes e depois do surto de crescimento). A etapa de validação do estudo compreendeu a utilização de 30 TCFC e demarcação de 25 pontos craniofaciais, a fim de avaliar a confiabilidade e precisão desses pontos nas regiões nasal, palatina e facial lateral. Dois métodos foram utilizados: 2D, em cortes multiplanares de TCFC no programa CS 3D Imaging; e 3D, com a segmentação 3D do crânio com visualização simultânea dos cortes multiplanares no programa ITK Snap. Os dados das coordenadas foram analisados por meio do Índice de Correlação Intraclasse (ICC), média das diferenças entre os tempos das medições, fórmula de Dahlberg e gráficos de Bland-Altman. A análise da relação entre a anatomia do septo nasal e morfologia do complexo nasomaxilar, compreendeu a utilização de 60 TCFC e a demarcação de 23 pontos bidimensionais e, avaliados quanto a presença de assimetria flutuante, por meio da análise de Procrustes ANOVA, comparação intergrupos com o teste de Mann- Whitney, além do teste de correlação de Spearman e regressão multivariada (a=0,05). Os resultados obtidos nas avaliações da reprodutibilidade dos pontos craniofaciais nos mostraram que o ICC variou de 0,95 a 1,0 no método 2D e foi maior ou igual a 0,99 no método 3D, indicando que ambos os métodos tiveram alta confiabilidade. A fórmula de Dahlberg, juntamente com Bland-Altman indicaram menor precisão nos pontos zigomáticomaxilar e orbitário no método 3D, e sutura zigomáticotemporal no método 2D. Os pontos ímpares (a maioria no plano sagital mediano) e os pontos frontozigomático temporal e frontozigomático orbital tiveram os melhores resultados de precisão. Com relação a influência do DSN e assimetrias no complexo nasomaxilar, nossos resultados principais mostraram que não foram observadas diferenças estatisticamente significativas entre as distâncias de Procrustes e Mahalanobis (assimetria flutuante) do complexo nasomaxilar entre os grupos avaliados (P>0.05). Entretanto, com os resultados da regressão multivariada, relacionado aos aspectos mais específicos de assimetria (componente assimétrico), houve uma correlação positiva entre o ângulo DSN e componente assimétrico das regiões palatinas (P=0.035 e P=0.047, média e posterior, respectivamente), e também com a forma do SN e componente assimétrico da região palatina anterior (P=0.039). Sendo assim, concluímos que, ambos os métodos 2D e 3D de marcação de pontos craniofaciais no complexo nasomaxilar e facial lateral apresentaram alta confiabilidade, entretanto, o método 2D apresentou maiores valores de precisão na maioria dos pontos avaliados. Além disso, todos os pontos avaliados neste estudo foram considerados aceitáveis para fins clínicos. Com relação a análise da anatomia do septo nasal e morfologia do complexo nasomaxilar, todos os grupos avaliados apresentaram níveis significativos de assimetria flutuante. Entretanto, não foram observadas diferenças significativas na assimetria flutuante do complexo nasomaxilar nos grupos com DSN leve em relação aos grupos com DSN moderado a severo, em ambos os estágios de maturação esquelética. Por fim, foi observada correlação positiva entre o ângulo DSN e o componente de assimetria nas regiões palatinas média e posterior e entre a forma do septo nasal e a região palatina anterior. Não foram observadas correlações significativas com as regiões nasal e lateral do complexo nasomaxilar. (AU)

The present study aimed to investigate the influence of nasal septum deviation (NSD) on the morphology of the nasomaxillary complex regarding reliability and accuracy in two-dimensional (2D) and three-dimensional (3D) craniofacial landmarks in cone beam computed tomography images (CBCT), verification of asymmetries of the nasomaxillary complex in individuals with different levels of NSD at different stages of skeletal maturation, and to analyze the association between the degree of severity of the NSD and the degree of asymmetry of the nasomaxillary complex. This was a retrospective, crosssectional observational study that used a total of 60 CBCT. For the validation study, 30 CTBC were used and 25 craniofacial landmarks were marked, in order to compare the reliability and precision of these landmarks in the nasal, palatal and lateral facial regions. Two methods were used: 2D, in CBCT multiplanar sections using CS 3D Imaging Software; and 3D, from the 3D segmentation of the skull in the software ITK Snap associated with multiplanar sections. Coordinates data were analyzed using the Intraclass Correlation Coefficient (ICC), Dalhberg's formula, Bland-Altman plots and mean differences between measurement trials. To study the relationship between nasal septum and nasomaxillary complex, the 60 CBCT were divided into 4 groups (n = 15) according to the degree of septal deviation and skeletal maturation (NSD <10°, mild nasal septum deviation, e NSD >10°, moderate to severe nasal septum deviation, both before and after the growth spurt). 23 two-dimensional landmarks were marked and, to assess asymmetries, we used Procrustes ANOVA, intergroups comparisons with the Mann-Whitney test, in addition to the Spearman's correlation test and multivariate regression. The results obtained in the evaluations of the reliability and precision of craniofacial landmarks showed that the ICC ranged from 0.95 to 1.0 in the 2D method and was greater than or equal to 0.99 in the 3D method, indicating that both methods had high reliability. Dahlberg's formula, together with Bland-Altman, indicated lower precision in the landmarks zygomaxillare and orbitale in the 3D method, and zygomaticotemporal suture in the 2D method. The unpaired landmarks (mainly located at the midsagittal plane) and the landmarks frontomalar temporale and frontomalar orbitale had the best results of precision. Regarding the influence of NSD and asymmetries in the nasomaxillary complex, our main results showed that no statistically significant differences were observed between the Procrustes and Mahalanobis distances (fluctuating asymmetry) of the nasomaxilar complex between the groups (P>0.05). However, with the results of the multivariate regression, related to the more specific aspects of asymmetry (asymmetry component), there was a positive correlation between the NSD angle and palatal regions (P=0.035 and P=0.047, middle and posterior, respectively), and also with the shape of the NS and the anterior palatal region (P=0.039). Therefore, we conclude that both the 2D and 3D methods of positioning craniofacial landmarks in the nasomaxillary complex and the lateral facial region showed high reliability, however, the 2D method showed higher precision values in most of the landmarks evaluated. Furthermore, all landmarks evaluated in this study are are reasonably considered acceptable for clinical purposes. Regarding the study of the nasal septum and nasomaxillary complex, all groups evaluated presented significant levels of fluctuating asymmetry. However, no significant differences were observed in the fluctuating asymmetry of the nasomaxillary complex in the groups with mild NSD compared to the groups with moderate to severe NSD, in both stages of skeletal maturation. Finally, a positive correlation was observed between the NSD angle and the asymmetry component in the middle and posterior palatine regions and between the shape of the nasal septum and the anterior palatine region asymmetry component. There were no significant correlations with the nasal and lateral regions of the nasomaxillary complex. (AU)