Correlation between cleft width and dental arch symmetry in cleft lip and palate: a longitudinal study

Abstract This study aimed to evaluate the influence of cleft width on dental arch symmetry of children with unilateral cleft lip and palate. Forty-one children were subjected to impression preoperatively (T1; mean age = 0.31 ± 0.07 years) and postoperatively (T2; mean age = 6 .73 ± 1.02 years). Eighty-two digitized dental casts were analyzed by stereophotogrammetry software. The cleft palate width was measured in the anterior (P-P'), middle (M-M'), and posterior (U-U') regions. Also, the following measurements were obtained: anterior intersegment (I-C') and intrasegment (I-C); total intersegment (I-T') and intrasegment (I-T); cleft-side (C'-T') and non-cleft-side (C-T) canine tuberosity. Paired t test and Pearson correlation coefficient were applied (α = 5%). Cleft width had the following means: 10.16 (± 3.46) mm for P-P', 12.45 (± 3.00) mm for M-M', and 12.57 (± 2.71) mm for U-U'. In the longitudinal analysis, I-C' had a significant reduction, while the other measurements significantly increased (p < 0.001). Asymmetry was verified in the following analyses at T1: I-C' vs. I-C and I-T' vs. I-T (p < 0.001); at T2, only in I-C' vs. I-C (p < 0.001). At T1, P-P' vs. I-C' (r = 0.722 and p < 0.001), P-P' vs. I-T' (r = 0.593 and p < 0.001), M-M' vs. I-C' (r = 0.620 and p < 0.001), and M-M' vs. I-T' (r = 0.327 and p < 0.05) showed a positive and significant correlation. At T2, there was a correlation between M-M' and I-C' (r = 0.377 and p < 0.05). In conclusion, the anterior and middle cleft widths influenced palatal asymmetry in the first months of life, while middle width influenced residual asymmetry.

Innovative method to assess maxillary arch morphology in oral cleft: 3d-3d superimposition technique

Abstract This study aimed to analyze the maxillary growth and development of children with oral clefts using the innovative method of 3D-3D superimposition technique. Children with unilateral complete cleft lip (UCL) and unilateral cleft lip and palate (UCLP) participated in the study. The impressions of the dental arches were executed 1 day before and 1 year after lip repair surgery. A 3D laser scanner digitized the dental models and the stereophotogrammetry system software analyzed the 3D-3D superimpositions in two groups of matches (same child, UCL and UCLP) and one group of mismatches (different individuals). The differences were evaluated by Root Mean Square (RMS) and expressed in millimeters (mm). Kruskal-Wallis test followed by post-hoc Dunn test and Mann-Whitney test were assessed to compare the groups (α=5%). RMS was 1.34 mm (± 0.37) in UCL group, 1.41 mm (± 0.32) in UCLP group, and 3.38 mm (± 1.28) in mismatches group. RMS was significantly greater in mismatches than in matches groups (p<0.0001). No statistically significant differences occurred between genders. The 3D-3D superimposition technique showed the maxillary development after lip repair surgery in the anterior region of the palate. Thus, it is suggested that the cleft amplitude and the palatal segments proportion influenced the morphological heterogeneity and, consequently, the development and maxillary growth of children with orofacial cleft.

Resumo O objetivo deste estudo foi analisar o crescimento e desenvolvimento maxilar de crianças com fissuras orais por meio de um método inovador da técnica de sobreposição 3D-3D. Participaram do estudo crianças com fissura unilateral completa de lábio (FL) e fissura unilateral de lábio e palato (FLP). As moldagens dos arcos dentários foram realizadas 1 dia antes e 1 ano após o reparo cirúrgico labial. Um scanner a laser 3D digitalizou os modelos dentários e o software do sistema de estereofotogrametria analisou as sobreposições 3D-3D em dois grupos correspondentes (mesmo indivíduo, FL e FLP) e um grupo não-correspondente (indivíduos diferentes). As diferenças foram avaliadas pelo Root Mean Square (RMS) e expressas em milímetros (mm). O teste de Kruskal-Wallis seguido do teste post-hoc de Dunn e teste de MannWhitney foram avaliados para comparar os grupos (α=5%). RMS foi de 1.34 mm (± 0.37) no grupo FL, 1.41 mm (± 0.32) no grupo FLP e 3.38 mm (± 1.28) no grupo não-correspondente. RMS foi significativamente maior no grupo não-correspondente (p <0.0001). Não houve diferenças estatisticamente significativas entre os gêneros. A técnica de sobreposição 3D-3D evidenciou o desenvolvimento da maxila após a cirurgia labial na região anterior do palato. Assim, sugere-se que a amplitude da fenda e a proporção dos segmentos palatinos influenciam na heterogeneidade morfológica e, consequentemente, no desenvolvimento e crescimento maxilar de crianças com fissura orofacial

Three-Dimensional Soft-Tissue Facial Morphometry in Caucasian Obese Adults

Objective: To evaluate the facial morphology of Caucasian obese adults in relation to normal weight peers, and to study the association between three-dimensional soft-tissue facial measurements and cardiometabolic risk factors. Material and Methods: Nineteen Caucasian obese subjects aged 25 to 73 years underwent anthropometric measurements, blood samples and a stereophotogrammetric facial scan. Soft-tissue facial linear distances, angles, and volumes were obtained and compared to those collected on normal weight subjects by computing z-scores. Spearman correlation was used to assess the associations between facial measurements and metabolic parameters. Logistic regression analysis adjusted for sex and age was used to assess the risk of metabolic syndrome associated to the facial measurements. Results: Overall, when compared to normal weight persons, obese adults had a wider face in the horizontal dimension, with a middle face (maxilla) that was larger both in absolute value and relatively to the lower face (mandible), and a larger right side gonial angle (Wilcoxon test, p < 0.01). Only the mean (left and right) gonial angle was positively associated to serum triglycerides level, while the other facial measurements were associated with none of the cardiometabolic parameters. Moreover, none of the facial measurements was associated with the risk of metabolic syndrome. Conclusion: Despite larger facial dimensions and altered mandible/maxilla volume ratio, three-dimensional soft-tissue facial morphometry in Caucasian obese adults is not related to cardiometabolic risk factors. The actual association between morphological facial characteristics and clinical information on the health conditions of patients is still to be investigated.

3D comparison of dental arch stability in patients with and without cleft lip and palate after orthodontic/rehabilitative treatment

Abstract This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.

Soft-tissue 3D Facial Imaging in Children and Adolescents: Towards the Definition of New Reference Standards

In the last decades, head and face imaging has shifted from two-dimensional (2D) representations (conventional radiography, photography) to three-dimensional (3D) techniques that can better depict the complex morphology of this part of the body, since they can provide a large number of additional anthropometric information [1-3]. 3D imaging systems can be divided into volumetric (computed tomography, cone beam computed tomography, magnetic resonance imaging) and optical surface instruments (laser scanning, moiré techniques, stereophotogrammetry, patterned light techniques) [4]. These last are safe and not invasive, and provide a 3D representation of the external (cutaneous) facial surface.

Tradução e adaptação transcultural do protocolo de avaliação miofuncional orofacial com escores para a Língua Italiana / Translation and cross-cultural adaptation of the protocol of orofacial myofunctional evaluation with scores for Italian Language

RESUMO O protocolo de avaliação miofuncional orofacial com escores (protocolo AMIOFE) é um instrumento validado para o diagnóstico de distúrbios miofuncionais orofaciais que pode ser utilizado por fonoaudiólogos em sua prática clínica. O presente estudo foi desenvolvido porque não há um instrumento validado para esta finalidade em língua Italiana. Objetivos: traduzir e realizar a adaptação transcultural do protocolo AMIOFE para a língua italiana e determinar os valores dos escores de normalidade em um grupo de jovens e adultos italianos. Métodos: o protocolo AMIOFE foi traduzido da língua inglesa para a italiana por três indivíduos bilíngues. A partir dessas traduções, uma versão de consenso foi preparada por um comitê de pesquisa (três fonoaudiólogos e um médico) e submetida a um comitê de juízes, composto por oito fonoaudiólogos italianos experientes na área. Os autores da versão original verificaram e aprovaram a versão italiana do protocolo. O instrumento foi testado por meio de avaliações de 40 sujeitos italianos jovens e adultos (faixa etária entre 18 e 56 anos de idade), realizadas por dois fonoaudiólogos. O ponto de corte, previamente descrito, foi usado para determinar as médias e desvios-padrão. Resultados: a etapa de tradução e a versão final da versão italiana do protocolo AMIOFE foram apresentadas, bem como as médias dos escores para os sujeitos com e sem distúrbio miofuncional orofacial. Conclusão: a versão italiana do protocolo AMIOFE foi desenvolvida, traduzida e adaptada transculturalmente. Valores de normalidade para sujeitos italianos jovens e adultos foram apresentados.

ABSTRACT The protocol of orofacial myofunctional evaluation with scores (OMES-protocol or AMIOFE in Portuguese language) is a validated instrument for the diagnosis of orofacial myofunctional disorders that can be used in clinical practice for speech-language pathologists. Because in the Italian language there is no validated tool for such purpose, this study was developed. Purposes: To translate and culturally adapt the OMES-protocol for Italian language and determine the normal score value in a group of young Italian adults. Methods: The OMES-protocol was translated from English to Italian by three bilingual individuals. From these translations, a consensus version was prepared by a research committee (three speech therapists and one physician and submitted to a committee of judges composed by eight speech therapists experienced in the area. The authors of the original version verified and approved the Italian version of the protocol. The instrument was tested via evaluations of 40 young and grown-up Italians (age range: 18-56 years) performed by two speech therapists. A cutoff score, previously described, was used to determine the mean and standard deviation. Results: The translation stage and the final Italian version of the OMES-protocol are shown. The mean of scores for individuals with and without orofacial myofunctional disorders were presented. Conclusion: The Italian version of the OMES-protocol was developed, translated, and cross-culturally adapted. Normal values for young and adult Italian subjects are presented.

Cinemática de variáveis de técnica-chave nos flic flacs de ginastas de elite / Kinematics of key technique variables in the backward handsprings of elite gymnasts

INTRODUÇÃO: A ginástica é o esporte de habilidades fechadas mais antigo e espetacular. Contudo, parâmetros técnicos de execução geralmente são somente ensinados por treinadores experientes. Desta maneira, existe uma lacuna de informações objetivas sobre o desempenho de ginastas (referências cinemáticas). OBJETIVO: No presente estudo, tentamos quantificar movimentos de inversão linear e de hiperextensão durante a execução de flic flacs. MÉTODOS: Foi efetuada uma detecção não invasiva de flic flacs com o auxílio de um instrumento óptico eletrônico 3D. Treze marcadores esféricos retrorreflexivos (1 cm de diâmetro) foram posicionados no corpo de 9 ginastas experientes: maléolos laterais direito e esquerdo, cabeça da fíbula, trocanter maior, acrômio, olecrano, processo estiloide da ulna e vértex. Na mesma sessão e após um período de aquecimento, cada participante executou 15 repetições de flic flacs. Dez repetições forma analisadas, e os trajetos 3D das 13 manobras medidos. RESULTADOS: Em média, os homens obtiveram altura vertical maior (mulheres, 62% da altura; homens, 58%). O alinhamento dos membros inferiores foi homogêneo entre os ginastas: ângulos posteriores de joelho variaram entre 80° e 118°. Nenhuma abdução de membro inferior foi observada: a largura de joelho foi 7 cm menor do que a largura intertrocanter; a largura de tornozelo foi 8 cm menor do que a largura de joelho. Na saída do movimento, o ângulo tronco-coxa apresentou excelente alinhamento corporal, com valores bem próximos de 180°. As mulheres executaram a fase de apoio das mãos com pulsos mais próximos do que os homens (homens, 134% de largura de ombro; mulheres, 121%). CONCLUSÃO: Os resultados podem fornecer informações para melhor conhecimento, definindo assim, a execução de padrão-ouro obtida de ginastas de elite com poucas lesões.

INTRODUCTION: Gymnastics is the most ancient and spectacular closed skills sport. Nonetheless, technical parameters of performance are often taught only by experienced trainers. Thus, there is a lack of objective data about gymnastics performance (kinematics references). OBJECTIVE: In the current study, we tried to quantify linear and hyperextension back movements during performance of backward handsprings. METHODS: A noninvasive detection of backward handsprings was made using a 3D optoelectronic instrument. Thirteen spherical retro-reflective markers (1-cm diameter) were positioned on the body of 9 experienced gymnasts: right and left lateral malleolus, fibular head, greater trochanter, acromion, olecranon, styloid process of the ulna; vertex. In the same session and after a warm-up period, each participant performed 15 repetitions of backward handsprings. Ten repetitions were analyzed, and the 3D tracks of the 13 landmarks measured. RESULTS: On average, men performed longer backward handsprings than women (men, 122% of height; women, 98%); women attained larger vertical height (women, 62% of height; men, 58%). Lower limb arrangement was homogenous among the gymnasts: posterior knee angles ranged between 80° and 118°. No lower limb abduction was observed: knee width was 7 cm smaller than intertrochanter width; ankle width was 8 cm smaller than knee width. At take-off, the trunk-thigh angle presented excellent body alignment, with values very close to 180°. Women performed the handstand phase with closer wrists than men (men, 134% of shoulder width; women, 121%). CONCLUSION: The results may offer data to improve understanding, defining gold-standard execution taken from high level gymnasts with few injuries.

A 3-year follow-up study of all-ceramic single and multiple crowns performed in a private practice: a prospective case series

OBJECTIVES: Zirconia-based prostheses are commonly used for aesthetic crown and fixed restorations, although follow-up data are limited, especially for implant-supported crowns. The aim of this study was to evaluate the threeyear clinical results of the installation of 463 zirconia core crowns by a general dental private practice. METHODS: This study followed 142 patients (69 men and 73 women; aged 28-82 years) who had received 248 single crowns (202 tooth-supported, 36 implant-supported) and 225 multiple units of up to six elements (81 toothsupported, 144 implant-supported). Clinical events, including fracture and loss of retention, secondary caries, and marginal integrity, were recorded. The overall failure rate was computed for the fractured and lost prostheses. Aesthetic, functional, and biological properties were rated, and patient satisfaction was investigated. RESULTS: During the three-year follow-up period, four patients were lost from the study (18 crowns, 4 percent of the total crowns). Three of the zirconia prostheses suffered fractures in more than three units (11 crowns; one- vs. three-year follow-up, p,0.05, Wilcoxon signed-rank test), and the cumulative prosthesis survival rate was 98.2 percent. Twelve units lost retention and were re-cemented, and no secondary caries of the abutment teeth were reported. The aesthetic, functional, and biological properties were generally well-rated, and there were no differences between tooth- and implant-supported crowns. The lowest scores were given regarding the anatomical form of the crowns, as some minor chipping was reported. Relatively low scores were also given for the periodontal response and the adjacent mucosa. Overall, patient satisfaction was high. CONCLUSIONS: At the three-year follow-up, the zirconia-core crowns appeared to be an effective clinical solution as they had favorable aesthetic and functional properties. Only the marginal fit of the prostheses should be improved upon.

Non-invasive 3D facial analysis and surface electromyography during functional pre-orthodontic therapy: a preliminary report

OBJECTIVES: Functional orthodontic devices can modify oral function thus permitting more adequate growth processes. The assessment of their effects should include both facial morphology and muscle function. This preliminary study investigated whether a preformed functional orthodontic device could induce variations in facial morphology and function along with correction of oral dysfunction in a group of orthodontic patients in the mixed and early permanent dentitions. MATERIAL AND METHODS: The three-dimensional coordinates of 50 facial landmarks (forehead, eyes, nose, cheeks, mouth, jaw and ears) were collected in 10 orthodontic male patients aged 8-13 years, and in 89 healthy reference boys of the same age. Soft tissue facial angles, distances, and ratios were computed. Surface electromyography of the masseter and temporalis muscles was performed, and standardized symmetry, muscular torque and activity were calculated. Soft-tissue facial modifications were analyzed non-invasively before and after a 6-month treatment with a functional device. Comparisons were made with z-scores and paired Student's t-tests. RESULTS: The 6-month treatment stimulated mandibular growth in the anterior and inferior directions, with significant variations in three-dimensional facial divergence and facial convexity. The modifications were larger in the patients than in reference children. In several occasions, the discrepancies relative to the norm became not significant after treatment. No significant variations in standardized muscular activity were found. CONCLUSIONS: Preliminary results showed that the continuous and correct use of the functional device induced measurable intraoral (dental arches) and extraoral (face) morphological modifications. The device did not modify the functional equilibrium of the masticatory muscles.