Craniofacial growth predictors for class II and III malocclusions: A systematic review.

OBJECTIVE: To evaluate the validity of craniofacial growth predictors in class II and III malocclusion. MATERIAL AND METHODS: An electronic search was conducted until August 2020 in PubMed, Cochrane Library, Embase, EBSCOhost, ScienceDirect, Scopus, Bireme, Lilacs and Scielo including all languages. The articles were selected and analyzed by two authors independently and the selected studies was assessed using the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The quality of evidence and strength of recommendation was assessed by the GRADE tool. RESULTS: In a selection process of two phases, 10 articles were included. The studies were grouped according to malocclusion growth predictor in (1) class II (n = 4); (2) class III (n = 5) and (3) class II and III (n = 1). The predictors were mainly based on data extracted from cephalometries and characterized by: equations, structural analysis, techniques and computer programs among others. The analyzed studies were methodologically heterogeneous and had low to moderate quality. For class II malocclusion, the predictors proposed in the studies with the best methodological quality were based on mathematical models and the Fishman system of maturation assessment. For class III malocclusion, the Fishman system could provide adequate growth prediction for short- and long-term. CONCLUSIONS: Because of the heterogeneity of the design, methodology and the quality of the articles reviewed, it is not possible to establish only a growth prediction system for class II and III malocclusion. High-quality cohort studies are needed, well defined data extraction from cephalometries, radiographies and clinical characteristics are required to design a reliable predictor.

Percepção dos Cirurgiões-Dentistas sobre o diagnóstico e manejo de pacientes portadores de maloclusão de Classe II Esquelética / Perception of Dental Surgeons on the diagnosis and management of patients with Skeletal Class II malocclusion

A compreensão de características dentoesqueléticas e faciais são imprescindíveis para o correto diagnóstico e tratamento ortodôntico. Quanto ao período correto de intervenção, o tratamento precoce se justifica para evitar o traumatismo dentário, desgastes dentários e a preservação da auto-estima da criança dentro da sociedade. Desta forma o trabalho tem por objetivo avaliar a percepção dos Cirurgiões-Dentistas sobre o diagnóstico, época ideal e tipos de tratamento da maloclusão de Classe II Esquelética, através de um artigo científico, realizado por meio de um questionário eletrônico para Cirurgiões-Dentistas (n=315), distribuído por meio de e-mail, Instagram e Facebook, constituído de 22 perguntas, determinando características sócio-demográficas, grau de percepção dos participantes, bem como época ideal e tipos de tratamentos para a maloclusão de Classe II Esquelética. Os dados foram tabulados no Programa Statistical Package for the Social Science (SPSS) versão 20.1 para Windows. Na verificação da normalidade da amostra, aplicou-se o teste ShapiroWilk, para comparação entre os grupos, foi realizado o teste T, o teste de regressão logística binária foi aplicado para mensurar o grau de relação e comportamento entre as variáveis quantitativas estudadas, o teste Qui-Quadrado e/ ou Exato de Fisher fora utilizado em busca de possíveis associações, foram consideradas associações positivas em presença de p valor <0,05. Sendo verificado que a maior parte dos entrevistados foram Odontopediatras (n=41,66% ± 9,82), gênero feminino (n=42,23 % ± 9,70) com média de idade (n=42,04% ± 9,09), oriundos da região Sudeste (n= 42,28% ± 9,58) que exerciam atividade clínica no serviço privado (n=42,30% ± 9,87). Não houve associação estatisticamente significativa em relação a auto-percepção de diagnóstico e o real conhecimento à respeito da maloclusão de Classe II Esquelética (p>0,05) em todas as especialidades perguntadas, exceto na especialidade Ortodontia. Para auxiliar a compreenção do diagnóstico da maloclusão de Classe II Esquelética, época de tratamento e tipos de mecanoterapia, foi criado um folheto explicativo no programa Canva.com, baseado em uma revisão de literatura sobre os assuntos acima, dentro da base de dados Med Line (via Pub Med e Web of Science). Além disto, foi realizado um relato de caso clínico sobre o tratamento precoce da maloclusão de Classe II Esquelética de uma criança de 6 anos e 8 meses tratada com disjunção maxilar e sequência de alinhadores (Invisalign®), objetivando a propulsão mandibular e a melhora da relação esquelética e de oclusão. Observou-se que o tratamento ortodôntico foi capaz de reduzir o overjet, melhorar as inclinações axiais individuais dentárias, atenuar o perfil esquelético, melhorar as funções estomatognáticas alteradas juntamente com ações interdisciplinares, assim como trouxe satisfação estética para a paciente e sua família. (AU)

An understanding of dentoskeletal and facial features are essential for correct diagnosis and orthodontic treatment. As for the correct period of intervention, early treatment is justified to avoid dental trauma, tooth wear and the preservation of the child's self-esteem within society. Thus, the work aims to assess the perception of dentists about the diagnosis, ideal time and types of treatment of Class II Skeletal Malocclusion, through a scientific article, carried out through an electronic questionnaire for dentists ( n=315), distributed through email, Instagram and Facebook, consisting of 22 questions, determining socio-demographic characteristics, degree of perception of the participants, as well as ideal time and types of treatments for Class II Skeletal Malocclusion . Data were tabulated in the Statistical Package for Social Science (SPSS) version 20.1 for Windows. To verify the normality of the sample, the Shapiro-Wilk test was applied to compare the groups, the T test was performed, the binary logistic regression test was applied to measure the degree of relationship and behavior between the quantitative variables studied, the Chi-Square and/or Fisher's Exact test had been used in search of possible associations, positive associations were considered in the presence of p value <0.05. It was verified that most respondents were pediatric dentists (n=41.66% ± 9.82), female (n=42.23 % ± 9.70) with mean age (n=42.04% ± 9 .09), from the Southeast region (n= 42.28% ± 9.58) who exercised clinical activity in the private service (n=42.30% ± 9.87). There was no statistically significant association regarding self-perception of diagnosis and real knowledge about Skeletal Class II Malocclusion (p>0.05) in all specialties asked, except for Orthodontists. To help understand the diagnosis of Class II Skeletal Malocclusion, time of treatment and types of mechanotherapy, an explanatory leaflet was created on the Canva.com program, based on a literature review on the above subjects, within the Med database Line (via Pub Med and Web of Science). In addition, a clinical case report was carried out on the early treatment of Class II Skeletal Malocclusion in a child aged 6 years and 8 months treated with maxillary disjunction and sequence of aligners (Invisalign®), aiming at mandibular propulsion and improvement of the skeletal relationship and occlusion. It was observed that orthodontic treatment was able to reduce overjet, improve individual dental axial inclinations, attenuate the skeletal profile, improve altered stomatognathic functions together with interdisciplinary actions, as well as bringing aesthetic satisfaction to the patient and her family. (AU)

Diagnóstico y plan de tratamiento de la Clase II / Diagnosis and treatment planning of Class II

En este artículo se consideran las condiciones que pueden modificar la valoración de la relación esquelética en el diagnóstico de la Clase II: desprogramación a relación céntrica, valoración de la clase esquelética, posición sagital del maxilar y de la mandíbula, el espacio de las vías aéreas, el torque de incisivos superiores e inferiores, la forma de la sínfisis, la interrelación con los planos vertical y transversal, y los caracteres faciales secundarios. A partir de estas conclusiones diagnósticas se desarrolla un plan de tratamiento que es equivalente tanto en casos de dentición mixta como permanente, pero utilizando diferentes aparatologías para conseguir mejores resultados de acuerdo al estado evolutivo de las arcadas dentarias(AU)

In this article, the conditions that can modify the evaluation of skeletal relationship in the diagnosis of Class II malocclusions are considered: deprogramming to centric relation, evaluation of skeletal class, sagittal position of maxilla and mandible, upper airways space, lower and upper incisors torque, shape of the symphysis, interrelationship between vertical and transverse planes, and secondary facial characteristics. From these diagnostic conclusions, a treatment plan is developed, that is similar in both mixed and permanent dentition cases, but using different appliances to get better results according to the evolutionary state of dental arches(AU)

Relación entre oclusión dentaria y postura cráneo-cervical en niños con maloclusiones clase II y III / Relationship between dental occlusion and craniocervical posture in children with class II and III malocclusions

RESUMEN Introducción: la relación entre las maloclusiones y la postura del sistema cráneo cervical ha generado un interés creciente entre los ortodontistas. Objetivo: describir la relación entre la oclusión dentaria y la postura del sistema cráneo-cervical en niños con maloclusiones clase II y clase III. Materiales y métodos: estudio descriptivo transversal. El universo estuvo formado por 19 niños, de 7 a 12 años, con maloclusiones clase II y III de Angle. Ingresados en el Servicio de Ortodoncia de la Facultad de Estomatología de La Habana, en octubre del 2016. Se realizó examen bucal y telerradiografía. Los resultados se presentaron en tablas. Resultados: predominó la clase II de Angle, donde la distoclusión molar fue más marcada en el lado derecho (-2,95 mm) y en la clase III la mesioclusión mayor correspondió al izquierdo (2,25 mm como promedio). En ambas predominó la ½ unidad (36,8 % en clase II). El ángulo cráneo-vertebral y el espacio suboccipital estuvieron dentro del rango normal; 104,65º y 7,99 mm, en clase II y en clase III, 103,78º y 6,90 mm como promedio. La profundidad de la columna cervical fue 6,26 mm y 6,20 mm respectivamente; lo que significó una rectificación de columna cervical. Conclusiones: se encontró más frecuente la clase II de Angle. La posición de la cabeza fue normal en ambas clases y la columna cervical rectificada. Se identificaron relaciones inversas entre la magnitud de la maloclusión con la posición de la cabeza y la columna cervical (AU).

ABSTRACT Introduction: the relationship between malocclusions and the crania-cervical system posture has generated a a growing interest among orthodontists. Objective: to describe the relationship between dental occlusion and the position of the crania-cervical system in children with class II and class III malocclusions. Materials and methods: cross-sectional, descriptive study. The universe was 19 children, aged from 7 to 12 years, class II and III Angle's malocclusions, admitted in the Orthodontics service of the Faculty of Stomatology of Havana in October 2016. Oral examination and teleradiography were performed. The results were presented in tables. Results: Class II of Angle predominated, where the molar distoclusion was more marked on the right side (-2.95 mm) and in class III the greater mesioclusion corresponded to the left (2.25 mm as average). In both, the ½ unit predominated (36.8% in Class II). The cranio-vertebral angle and the suboccipital space were within the normal range; 104.65º and 7.99 mm in class II and in class III 103.78º and 6.90 mm as average. The depth of the cervical spine was 6.26 mm and 6.20 mm respectively; which meant a rectification of the cervical spine. Conclusions: Angle's Class II was found more frequent. The position of the head was normal in both classes and also the rectified cervical spine. Inverse relationships were identified between the magnitude of the malocclusion and the position of the head and cervical spine. The objective of this work is to present a clinical case and the importance of a nurse intervention (AU).

Relación entre oclusión dentaria y postura cráneo-cervical en niños con maloclusiones clase II y III / Relationship between dental occlusion and craniocervical posture in children with class II and III malocclusions

RESUMEN Introducción: la relación entre las maloclusiones y la postura del sistema cráneo cervical ha generado un interés creciente entre los ortodontistas. Objetivo: describir la relación entre la oclusión dentaria y la postura del sistema cráneo-cervical en niños con maloclusiones clase II y clase III. Materiales y métodos: estudio descriptivo transversal. El universo estuvo formado por 19 niños, de 7 a 12 años, con maloclusiones clase II y III de Angle. Ingresados en el Servicio de Ortodoncia de la Facultad de Estomatología de La Habana, en octubre del 2016. Se realizó examen bucal y telerradiografía. Los resultados se presentaron en tablas. Resultados: predominó la clase II de Angle, donde la distoclusión molar fue más marcada en el lado derecho (-2,95 mm) y en la clase III la mesioclusión mayor correspondió al izquierdo (2,25 mm como promedio). En ambas predominó la ½ unidad (36,8 % en clase II). El ángulo cráneo-vertebral y el espacio suboccipital estuvieron dentro del rango normal; 104,65º y 7,99 mm, en clase II y en clase III, 103,78º y 6,90 mm como promedio. La profundidad de la columna cervical fue 6,26 mm y 6,20 mm respectivamente; lo que significó una rectificación de columna cervical. Conclusiones: se encontró más frecuente la clase II de Angle. La posición de la cabeza fue normal en ambas clases y la columna cervical rectificada. Se identificaron relaciones inversas entre la magnitud de la maloclusión con la posición de la cabeza y la columna cervical.

ABSTRACT Introduction: the relationship between malocclusions and the crania-cervical system posture has generated a a growing interest among orthodontists. Objective: to describe the relationship between dental occlusion and the position of the crania-cervical system in children with class II and class III malocclusions. Materials and methods: cross-sectional, descriptive study. The universe was 19 children, aged from 7 to 12 years, class II and III Angle's malocclusions, admitted in the Orthodontics service of the Faculty of Stomatology of Havana in October 2016. Oral examination and teleradiography were performed. The results were presented in tables. Results: Class II of Angle predominated, where the molar distoclusion was more marked on the right side (-2.95 mm) and in class III the greater mesioclusion corresponded to the left (2.25 mm as average). In both, the ½ unit predominated (36.8% in Class II). The cranio-vertebral angle and the suboccipital space were within the normal range; 104.65º and 7.99 mm in class II and in class III 103.78º and 6.90 mm as average. The depth of the cervical spine was 6.26 mm and 6.20 mm respectively; which meant a rectification of the cervical spine. Conclusions: Angle's Class II was found more frequent. The position of the head was normal in both classes and also the rectified cervical spine. Inverse relationships were identified between the magnitude of the malocclusion and the position of the head and cervical spine. The objective of this work is to present a clinical case and the importance of a nurse intervention.

Angle Class II, Division 2 Malocclusion and Association with Late Eruption

Objective: To verify the dental age of individuals with Angle Class II, division 2 malocclusion. Material and Methods: The sample consisted of 200 panoramic radiographs of schoolchildren from the city of Fortaleza in the state of Ceará, in the northeast of Brazil. These radiographs were divided into two groups (N=100): a Control group comprising radiographs of patients with normal occlusion and a CIID2 group comprising radiographs of patients with an Angle Class II, division 2 malocclusion. The Demirjian method was used to identify dental age. All the radiographs were evaluated by a sole duly trained and calibrated technician. The Kappa coefficient for inter-annotator agreement was 0.98 based on the criteria of eruption stage of each tooth. Statistical analysis was performed using the Chi-squared test, Student's t-test and the Mann-Whitney test, with a level of significance of 5%. Results: There was a significant statistical difference between the dental ages of the groups tested. The CIID2 group had a lower dental age than the control group, signifying late eruption in patients with an Angle Class II, division 2 malocclusion. Conclusion: Patients with an Angle Class II, division 2 malocclusion had a lower dental age than patients with normal occlusion, suggesting that orthodontic treatment should be delayed. The first molars, second pre-molars and canines suffered late eruption.

Sensitivity and Specificity of Cephalometric Measures for the Diagnosis of Sagittal Skeletal Malocclusion

Objective: To evaluate and compare sensitivity and specificity of ANB, Wits, APDI and AF-BF to diagnose sagittal skeletal malocclusions, in children between 6 to 12 years old, using ROC curves, a widely accepted method for the analysis and evaluation of diagnostic tests. Material and Methods: A descriptive-comparative study of diagnostic tests was conducted. From a population of 3,000 children, a non-probabilistic sample of 209 was selected. The clinical classification of the patients as class I, II or III, made by a group of experts based on the visual inspection of models and photographs, was chosen as the gold standard. After calibration (ICC>0.94) the variables were measured in cephalograms. Eight ROC curves were plotted (I vs II, and I vs III for each one of the variables). The area under the curve was measured and compared (Ji-square test). Cut points were established. Results: To discriminate Class I from II, ANB showed the largest area under the curve (AUC) (0.876) and the cut point (best sensitivity and specificity) was at 5.75°. To discriminate class I from III, Wits showed the largest AUC (0.874) with a cut point of -3.25 mm. There were no statistical differences between the AUC for the four variables (p=0.48 y p=0.38 for class I-II and I-III). Conclusion: ANB and Wits performed better for the diagnosis of class II and III, respectively. Cut points in children were different from those reported in adults.

Comparing the Clinical Success Rate of Self-Drilling and Self-Tapping Mini-screws in the Retraction of Maxillary Anterior Teeth

Objective: To compare the success of self-drilling and self-tapping methods in the retraction of maxillary anterior teeth. Material and Methods: The study was conducted in 57 subjects with Cl II malocclusion who needed to be treated with extraction of four maxillary teeth. The selftapping method was used on the left side and the self-drilling method was used on the right side. Then, the pain rate of each method was recorded by the numerical rating scale (NRS). Statistical analysis was done by t-test and Chi-square test. The significance level in this study was considered at p-value<0.05. Results: Considering the clinical mobility as the failure, the success of treatment was equal in both methods and was 93%. The inflammation around the mini-screws was 8.8%. A significant relationship was found between the variables inflammation and success (p<0.05). The mean pain was 2.47 but there was no significant difference between the two methods in terms of pain score (p>0.05). There was a significant difference between the groups (p=0.03). The pain was significantly higher in the female. Conclusion: There is no difference between self-drilling and self-tapping methods in terms of success. Comparison of the pain between two genders according to the replantation method showed a significant difference in pain sensation between two genders. The pain sensation mean in female group was greater than male group.

Diagnostic validity of different cephalometric analyses for assessment of the sagittal skeletal pattern.

INTRODUCTION: Numerous cephalometric analyses have been proposed to diagnose the sagittal discrepancy of the craniofacial structures. OBJECTIVE: This study aimed at evaluating the reliability and validity of different skeletal analyses for the identification of sagittal skeletal pattern. METHODS: A total of 146 subjects (males = 77; females = 69; mean age = 23.6 ± 4.6 years) were included. The ANB angle, Wits appraisal, Beta angle, AB plane angle, Downs angle of convexity and W angle were used to assess the anteroposterior skeletal pattern on lateral cephalograms. The sample was classified into Class I, II and III groups as determined by the diagnostic results of majority of the parameters. The validity and reliability of the aforementioned analyses were determined using Kappa statistics, sensitivity and positive predictive value (PPV). RESULTS: A substantial agreement was present between ANB angle and the diagnosis made by the final group (k = 0.802). In the Class I group, Downs angle of convexity showed the highest sensitivity (0.968), whereas ANB showed the highest PPV (0.910). In the Class II group, ANB angle showed the highest sensitivity (0.928) and PPV (0.951). In the Class III group, the ANB angle, the Wits appraisal and the Beta angle showed the highest sensitivity (0.902), whereas the Downs angle of convexity and the ANB angle showed the highest PPV (1.00). CONCLUSION: The ANB angle was found to be the most valid and reliable indicator in all sagittal groups. Downs angle of convexity, Wits appraisal and Beta angle may be used as valid indicators to assess the Class III sagittal pattern.

Diagnostic validity of different cephalometric analyses for assessment of the sagittal skeletal pattern

Abstract Introduction: Numerous cephalometric analyses have been proposed to diagnose the sagittal discrepancy of the craniofacial structures. Objective: This study aimed at evaluating the reliability and validity of different skeletal analyses for the identification of sagittal skeletal pattern. Methods: A total of 146 subjects (males = 77; females = 69; mean age = 23.6 ± 4.6 years) were included. The ANB angle, Wits appraisal, Beta angle, AB plane angle, Downs angle of convexity and W angle were used to assess the anteroposterior skeletal pattern on lateral cephalograms. The sample was classified into Class I, II and III groups as determined by the diagnostic results of majority of the parameters. The validity and reliability of the aforementioned analyses were determined using Kappa statistics, sensitivity and positive predictive value (PPV). Results: A substantial agreement was present between ANB angle and the diagnosis made by the final group (k = 0.802). In the Class I group, Downs angle of convexity showed the highest sensitivity (0.968), whereas ANB showed the highest PPV (0.910). In the Class II group, ANB angle showed the highest sensitivity (0.928) and PPV (0.951). In the Class III group, the ANB angle, the Wits appraisal and the Beta angle showed the highest sensitivity (0.902), whereas the Downs angle of convexity and the ANB angle showed the highest PPV (1.00). Conclusion: The ANB angle was found to be the most valid and reliable indicator in all sagittal groups. Downs angle of convexity, Wits appraisal and Beta angle may be used as valid indicators to assess the Class III sagittal pattern.

Resumo Introdução: numerosas análises cefalométricas foram propostas para diagnosticar a discrepância sagital das estruturas craniofaciais. Objetivo: este estudo teve como objetivo avaliar a confiabilidade e validade de diferentes análises esqueléticas para a identificação do padrão esquelético sagital. Métodos: foram incluídos 146 indivíduos (homens = 77; mulheres = 69; idade média = 23,6 ± 4,6 anos). O ângulo ANB, a avaliação de Wits, o ângulo Beta, o ângulo do plano AB, o ângulo de convexidade de Downs e o ângulo W foram utilizados para avaliar o padrão esquelético anteroposterior em cefalogramas laterais. A amostra foi classificada nos grupos Classe I, II e III, conforme os resultados diagnósticos da maioria dos parâmetros. A validade e a confiabilidade das análises acima mencionadas foram determinadas usando estatísticas Kappa, sensibilidade e valor preditivo positivo (VPP). Resultados: foi encontrada uma concordância significativa entre o ângulo ANB e o diagnóstico feito pelo grupo final (k = 0,802). No grupo Classe I, o ângulo de convexidade de Downs mostrou a maior sensibilidade (0,968), enquanto o ANB apresentou o maior VPP (0,910). No grupo Classe II, o ângulo ANB mostrou a maior sensibilidade (0,928) e o maior VPP (0,951). No grupo Classe III, o ângulo ANB, a avaliação de Wits e o ângulo Beta apresentaram a maior sensibilidade (0,902), enquanto o ângulo de convexidade de Downs e o ângulo ANB apresentaram o maior VPP (1,00). Conclusão: o ângulo ANB foi considerado o indicador mais válido e confiável em todos os grupos sagitais. O ângulo de convexidade de Downs, a avaliação de Wits e o ângulo Beta podem ser usados como indicadores válidos para avaliar o padrão sagital de Classe III.

Resultados del tratamiento de maloclusión clase II división 1 con activador abierto elástico de Klammt / Results of type II division 1 malocclusion treatment, with Klammt elastic open activator

Fundamento: El activador abierto elástico de Klammt ha sido utilizado en Cuba en los últimos años. Es un aparato funcional que se encuentra entre las opciones de tratamiento de la maloclusión clase II división 1.Objetivo: describir los resultados del tratamiento ortopédico para la corrección de maloclusión clase II división 1 con activador abierto elástico de Klammt.Métodos: se realizó un estudio de intervención, cuasiexperimental, que incluyó a 20 niños de la escuela primaria Antonio Maceo, del Área de Salud II del municipio Cienfuegos. Para el diagnóstico se tomaron telerradiografías laterales de cráneo al inicio y al año de tratamiento, a las cuales se aplicaron mediciones lineales y/o angulares de Steiner, Ricketts y McNamara. Se evaluaron los cambios cefalométricos esqueletales y de tejidos blandos antes y después del tratamiento.Resultados: se observaron cambios en las mediciones de las radiografías laterales del cráneo, con variaciones cefalométricas cráneofaciales de significación estadística importante; lo mismo ocurrió en los tejidos blandos, que denotaron en general un mejoramiento del perfil, sobre todo del ángulo nasolabial, esencialmente originado en su componente labial.Conclusión: se constató la efectividad del activador abierto elástico de Klammt en el tratamiento de las maloclusiones clase II división 1, ya que se logró la corrección de estas en pacientes de edades tempranas, lo cual se evidenció en las variaciones resultantes en el biotipo facial hacia patrones más favorables(AU)

Foundation: Klammt elastic open activator has been used in Cuba in the last years. It is a fuctional aparathus whis is found among the treatment options for type II division 1 maloclussion.Objective: To describe Klammt elastic open activator for correcting type II division 1 maloclussion with Klammt elastic open activator.Methods: A quasi-experimental intervention was carried out, including 20 children from the Antonio Maceo elementary school, from the Cienfuegos municipality Health Area II. For the diagnosis skull lateral cephalograms were taken at the beginning and at a year time from treatment beginning, to which linear and/or angular measurements of Steiner, Ricketts and McNamara were applied. Changes in measurements of skull lateral radiographs were observed, with cephalometric variations of craniofacial of important statistical significance; the same occurred in soft tissues, which generally denoted an improvement of the profile, especially of the nasolabial angle, essentially originating in its labial component. Skeletal and soft tissue cephalometric changes were evaluated before and after treatment.Results: Changes in measurements of skull lateral radiographs were observed, with cephalometric variations of craniofacial of important statistical significance; The same occurred in soft tissues, which generally denoted a profile improvement, especially of the nasolabial angle, essentially originating in its labial component.Conclusion: The effectiveness of Klammt elastic open activator in the treatment of class II malocclusions division 1 was verified, as it was corrected in patients of early age, which was evidenced in the resulting variations in the facial biotype towards more favorable patterns(AU)

Class II malocclusion with accentuated occlusal plane inclination corrected with miniplate: a case report.

INTRODUCTION: A canted occlusal plane presents an unesthetic element of the smile. The correction of this asymmetry has been typically considered difficult by orthodontists, as it requires complex mechanics and may sometimes even require orthognathic surgery. OBJECTIVE: This paper outlines the case of a 29-year-old woman with Class II malocclusion, pronounced midline deviation and accentuated occlusal plane inclination caused by mandibular deciduous molar ankylosis. METHODS: The patient was treated with a miniplate used to provide anchorage in order to intrude maxillary teeth and extrude mandibular teeth on one side, thus eliminating asymmetry. Class II was corrected on the left side by means of distalization, anchored in the miniplate as well. On the right side, maxillary first premolar was extracted and molar relationship was kept in Class II, while canines were moved to Class I relationship. The patient received implant-prosthetic rehabilitation for maxillary left lateral incisor and mandibular left second premolar. RESULTS: At the end of treatment, Class II was corrected, midlines were matched and the canted occlusal plane was totally corrected, thereby improving smile function and esthetics.

Class II malocclusion with accentuated occlusal plane inclination corrected with miniplate: a case report

ABSTRACT Introduction: A canted occlusal plane presents an unesthetic element of the smile. The correction of this asymmetry has been typically considered difficult by orthodontists, as it requires complex mechanics and may sometimes even require orthognathic surgery. Objective: This paper outlines the case of a 29-year-old woman with Class II malocclusion, pronounced midline deviation and accentuated occlusal plane inclination caused by mandibular deciduous molar ankylosis. Methods: The patient was treated with a miniplate used to provide anchorage in order to intrude maxillary teeth and extrude mandibular teeth on one side, thus eliminating asymmetry. Class II was corrected on the left side by means of distalization, anchored in the miniplate as well. On the right side, maxillary first premolar was extracted and molar relationship was kept in Class II, while canines were moved to Class I relationship. The patient received implant-prosthetic rehabilitation for maxillary left lateral incisor and mandibular left second premolar. Results: At the end of treatment, Class II was corrected, midlines were matched and the canted occlusal plane was totally corrected, thereby improving smile function and esthetics.

RESUMO Introdução: o plano oclusal inclinado representa um elemento antiestético para o sorriso. A correção dessa assimetria é normalmente considerada difícil pelos ortodontistas, requerendo mecânica complexa e, algumas vezes, até cirurgia ortognática. Objetivo: esse artigo descreve o caso de uma paciente de 29 anos, portadora de má oclusão de Classe II, com considerável desvio das linhas médias e acentuada inclinação do plano oclusal, causada pela anquilose de molar decíduo inferior. Métodos: a paciente foi tratada com ancoragem em miniplaca, para promover a intrusão dos dentes superiores e extrusão dos dentes inferiores em um lado, eliminando a assimetria. A Classe II foi corrigida no lado esquerdo por meio de distalização, também ancorada na miniplaca. No lado direito, o primeiro pré-molar superior foi extraído e a relação de molares de Classe II foi mantida, enquanto os caninos foram movidos para relação de Classe I. A paciente recebeu reabilitação por meio de implante e prótese no incisivo lateral superior esquerdo e no segundo pré-molar inferior esquerdo. Resultados: ao término do tratamento, a Classe II foi corrigida, as linhas médias estavam coincidentes e a inclinação do plano oclusal foi totalmente corrigida, melhorando consideravelmente os aspectos funcionais e estéticos da oclusão.

Influence of Facial and Occlusal Characteristics on Gummy Smile in Children: A Case-Control Study

Objective: To determine the association between occlusal and soft tissue characteristics with the presence of gingival smile (GS) in a pediatric population with inter-transitional mixed dentition. Material and Methods: Case-control study was performed with a probabilistic sample of 163 children in inter-transitional mixed dentition (age:8.8 years ±0.8). Cases were 37 children with GS, and controls were 126 children without GS. Occlusal variables were assessed through clinical examination, and soft tissue variables were assessed through photograms. Kappa test and intraclass correlation coefficient were done (0.87-0.96). The association between malocclusion, gender, and types of smile was assessed using a Chi square test. Comparison of quantitative variables in smile groups was made by Student t test. A multivariate binary logistic regression was performed. Results: Class II malocclusion, short upper lip at smile and short incisor clinical crown, were risk factors for gummy smile (OR= 10.4, 95%CI 3.07- 34.95, OR= 2.1, 95%CI 1.44- 3.13 and OR= 2.5 95%CI 1.34- 4.54 respectively). Lower facial height was a protective factor against GS (OR= 0.76; 95%CI 0.69- 0.85). The logistic regression model explains 48% of GS variability. Conclusion: Class II malocclusion is considered a risk factor for gummy smile. Other variables associated to gummy smile were short upper lip and short incisor clinical crown. Clinicians should considered these aspects in clinical examination of each patient to provide an adequate diagnostic and plan of treatment to control and/or correct a GS.

Avaliação fenotípica em portadores de maloclusão classe II esquelética / Phenotypic evaluation in patients with skeletal class II malocclusion

Objetivo: Avaliar os principais componentes da maloclusão de Classe II esquelética e os seus subgrupos para melhor caracterizar este fenótipo e melhorar o diagnóstico. Foram avaliados 502 prontuários de indivíduos atendidos na clínica de mestrado em Ortodontia do Departamento de Odontopediatria e Ortodontia da Universidade Federal do Rio de Janeiro no período de agosto de 2015 a janeiro de 2016. Para isso, foram incluídos 40 prontuários de indivíduos portadores de maloclusão de Classe II esquelética, caracterizados com ângulo ANB > 4°. Foram excluídos portadores de síndromes, fenda labiopalatina, pacientes em crescimento, prontuários incompletos e radiografias iniciais de paciente realizadas previamente ao tratamento ortodôntico. Para análise estatística foram aplicados os testes do Quiquadrado e/ou exato de Fisher (p<0.05), regressão logística multivariada, análise dos componentes principais e método de Cluster. Os resultados encontrados demonstraram 4 componentes principais morfológicos relacionados a Classe II, sendo avaliados tamanho e posição de maxila e mandíbula, tipo facial definido pela direção de crescimento e perfil tegumentar. Quatro subgrupos foram verificados caracterizando a Classe II. Conclui-se que a maloclusão de Classe II esquelética apresenta 4 principais componentes morfológicos e quatro subgrupos característicos o que pode melhorar o diagnóstico e auxiliar estudos em genética (AU)

Purpose: To evaluate the main components of skeletal Class II malocclusion and its subgroups to better characterize the phenotype and to improve the diagnosis. Methods: We evaluated 502 medical records of patients who were attended the Pediatric dentistry and Orthodontics Department of the Federal University of Rio de Janeiro, between August 2015 and January 2016. We excluded individuals with Syndromes, cleft lip and palate, incomplete records, growing patients and the initial radiograph realized after the orthodontic treatment be conducted. Forty medical records were included, which comprised patients with skeletal Class II malocclusion, according to Steiner measurements, ANB> 4°. Statistical analysis were carried out trough chi-square and / or Fisher exact test (p <0.05), multivariate logistic regression, principal component analysis and cluster method. Results: We found 4 morphological main components related to skeletal Class II, that were related to the size and to the position of the maxilla and mandible, facial type was defined by the direction of growth and soft tissue profile. Four subgroups were evaluated underlying the skeletal Class II malocclusion. Thereby, we concluded that the skeletal Class II malocclusion presented four main morphological components and four subgroups with similar features, which can improve the diagnosis and to add genetic studies (AU)

Un tratamiento antiguo y vigente en ortodoncia: expansión rápida maxilar / An old and current orthodontic treatment: rapid maxillary expansion

Las anomalías transversales se presentan frecuentemente desde edades tempranas. Generalmente son causadas por problemas funcionales como deglución atípica y respiración bucal. Las alteraciones de la oclusión sobre el plano transversal son conocidas como mordidas cruzadas posteriores, pudiendo ser de origen dentario o esqueletal. Si el diagnóstico de nuestro paciente es una compresión maxilar de origen esqueletal, el tratamiento indicado será la expansión rápida del maxilar (ERM). La corrección de la deficiencia transversal del maxilar superior con el uso del disyuntor, constituye un recurso terapéutico capaz de cambiar las relaciones dentarias y esqueléticas en una primera fase del tratamiento, utilizando al máximo los cambios dinámicos asociados con el crecimiento y preparando un mejor entorno orofacial para la erupción de la dentición permanente. En este trabajo se desarrollan tres casos clínicos que modificaron notoriamente su morfología luego del tratamiento con ERM mediante el uso de diferentes tipos de disyuntores...

Correlation between the Rotation of the First Molars and the Severity of Class II Division 1 Malocclusion.

This study aimed to evaluate the potential correlation between the severity of Class II division 1 malocclusion and the magnitude of mesiopalatal rotation of the maxillary first molars. Scanned images of 104 cast models were grouped according to the severity of Class II malocclusion as follows: Group 1, 1/4 Class II malocclusion; Group 2, 1/2 Class II malocclusion; Group 3, 3/4 Class II malocclusion; and Group 4, complete Class II malocclusion. The rotation was measured using parameters described by Henry, Friel, and Ricketts, referred to as indicators 1, 2, and 3, respectively. The correlation was evaluated using the Spearman's correlation coefficient. The rotational indicators were compared using one-way analysis of variance. For all statistical analyses used p < 0.05, a positive correlation was observed between the severity of Class II malocclusion and the mesiopalatal rotation of the maxillary first molar. This correlation was statistically significant for indicator 1 between Groups 1 and 3 and for indicator 2 between Groups 1 and 4, which include cases of extreme malocclusion. In conclusion, there is a positive correlation between the severity of Class II division 1 malocclusion and the magnitude of mesiopalatal rotation in the maxillary first molars.

Semi-longitudinal study of the McNamara cephalometric triangle in Class II and Class III subjects grouped by cervical vertebrae maturation stage

El objetivo del estudio fue comparar los valores del triángulo cefalométrico de McNamara en sujetos normodivergentes no tratados con maloclusión de Clase II y Clase III, de origen latinoamericano, agrupados por estadío de maduración devértebras cervicales, en comparación con un grupo control sin tratamiento, normodivergentes y con maloclusión de Clase I. El estudio se realizó sobre una muestra de seiscientos diez cefalogramas laterales de cabeza pretratamiento (250 hombres, 360 mujeres) que fueron agrupados de acuerdo a su relación esquelética sagital (Clase I, II ó III), estadío de maduración vértebras cervicales (pre pico puberal P1 = CS1 y CS2, pico puberal P2 = CS3 y CS4, y post pico puberal P3 = CS5 y CS6) y sexo. Se midió en cada cefalograma el triángulocefalométrico de McNamara Co-A, Co-Gn y ENA-Me. Se realizaron las pruebas de ANOVA y post-hoc Tukey HSD paradeterminar las diferencias entre grupos. Los resultados en hombres muestran que los mayores aumentos maxilares ymandibulares se produjeron durante la etapa P3 (CS5 para CS6), mientras que en las mujeres se produjeron en la etapaP2 (CS3 para CS4). Las distancias Co-A y Co-Gn muestran diferencias significativas entre las diferentes clases (p <0,05). La longitud maxilar de los sujetos de Clase II y la longitudmandibular de los sujetos de Clase III estuvieron aumentadas al inicio del período evaluado (P1). Se identificó una tendencia al empeoramiento de las maloclusiones de Clase II y III durante el período evaluado. Finalmente los cambios en los valores del triángulo cefalométrico de McNamara fueron marcadamente diferentes en las tres clases de maloclusión en sujetos normodivergentes. En estos sujetos latinoamericanos el estirón puberal se produjo en momentos diferentes con respecto a la raza caucásica y lasnormas asiáticas...

Photographic assessment of hyperdivergent skeletal Class II patients / Avaliação fotográfica de pacientes padrão esquelético classe II hiperdivergentes

Desordens temporomandibulares, distúrbios do sono por obstrução das vias aéreas e alterações na postura crânio cervical constituem alguns dos problemas que têm sido relacionados com o paciente padrão esquelético classe II hiperdivergente. Embora as telerradiografias laterais representem o padrão ouro para o diagnóstico da morfologia cranio facial na prática clínica, este exame pode não ser viável para aplicação em estudos epidemiológicos de larga escala. Objetivo: O objetivo deste estudo foi testar a validade de um novo método fotográfico no diagnóstico de pacientes classe II hiperdivergentes para fins de investigação epidemiológica. Material e Métodos: Telerradiografias laterais e fotografias de perfil foram obtidas a partir de 123 indivíduos distribuídos em dois grupos: 51 pacientes compuseram o grupo de pacientes classe II hiperdivergente, enquanto que os outros 72 pacientes formaram um segundo grupo. A análise discriminante descreveu um modelo matemático para melhor diagnosticar pacientes padrão esquelético classe II hiperdivergente através de fotografias. Resultados: Uma função canônica discriminante composta por duas variáveis fotográficas classificou corretamente 85% dos pacientes classe II hiperdivergentes durante a validação interna (p < 0,001). O método mostrou 83% de sensibilidade e 73% de especificidade no processo de validação externa. Conclusão: O método fotográfico pode ser considerado como uma alternativa viável e prática para diagnosticar o paciente classe II hiperdivergente, particularmente se existir a necessidade de um método não invasivo e de baixo custo.

Temporomandibular disorders, sleep disturbances by airway obstruction and craniocervical posture changes constitute some of the problems that have been related to hyperdivergent skeletal Class II patients. Although cephalometric radiographs represent the gold standard for diagnosing craniofacial morphology in clinical practice, it might not be feasible for large-scale epidemiological research. Objectives: The aim of this study was to test the validity of a new photographic method in diagnosing hyperdivergent skeletal Class II patients for epidemiological research purposes. Material and Methods: Lateral cephalograms and profile photographs were obtained from 123 subjects assigned into two groups. 51 patients comprised the hyperdivergent skeletal Class II group and the other 72 composed a second group. Discriminant analysis described a mathematical model to better diagnose hyperdivergent skeletal Class II patients through photographs. Results: A canonical discriminant function composed of two photographic variables correctly classified 85% of the hyperdivergent skeletal Class II patients during internal validation (p < 0.001). The method showed 83% sensitivity and 73% specificity in external validation procedure. Conclusion: The photographic method may be a feasible and practical alternative for diagnosing the hyperdivergent skeletal Class II patient, particularly if there is a need for a low-cost and noninvasive method.

Cephalometric evaluation of the predictability of bimaxillary surgical-orthodontic treatment outcomes in long face pattern patients: a retrospective study.

OBJECTIVE: The aim of this study was to compare by means of McNamara as well as Legan and Burstone's cephalometric analyses, both manual and digitized (by Dentofacial Planner Plus and Dolphin Image software) prediction tracings to post-surgical results. METHODS: Pre and post-surgical teleradiographs (6 months) of 25 long face patients subjected to combined orthognathic surgery were selected. Manual and computerized prediction tracings of each patient were performed and cephalometrically compared to post-surgical outcomes. This protocol was repeated in order to evaluate the method error and statistical evaluation was conducted by means of analysis of variance and Tukey's test. RESULTS: A higher frequency of cephalometric variables, which were not statistically different from the actual post-surgical results for the manual method, was observed. It was followed by DFPlus and Dolphin software; in which similar cephalometric values for most variables were observed. CONCLUSION: It was concluded that the manual method seemed more reliable, although the predictability of the evaluated methods (computerized and manual) proved to be reasonably satisfactory and similar.