Computed tomography imaging superimposition protocols to assess outcomes in orthognathic surgery: a systematic review with comprehensive recommendations.

OBJECTIVES: A systematic review was performed to analyze the current evidence on three-dimensional (3D) computed tomography (CT) superimposition protocols used to assess dentomaxillofacial changes after orthognathic and orthofacial surgery. Accuracy, reproducibility, and efficiency were evaluated. METHODS: The search was divided into Main Search (PubMed, EMBASE, Cochrane Library, LILACS, and SciELO), Grey Literature search (Google Scholar and Open Grey), and Manual search. Thirteen studies were included. Of these, 10 reported data on accuracy, 10 on reproducibility and five on efficiency. Seven proposed or evaluated methods of voxel-based superimposition, three focused on the surface-based technique, one compared surface- and voxel-based superimposition protocols, one used the maximum mutual information algorithm, and one described a landmark-based superimposition method. Cone-beam computed tomography (CBCT) was the most common imaging technique, being used in 10 studies. RESULTS: The accuracy of most methods was high, showing mean differences smaller than voxels' dimensions, ranging between 0.05 and 1.76 mm for translational accuracy, and 0.10-1.09° for rotational accuracy. The overall reproducibility was considered good as demonstrated by the small mean error (range: 0.01-0.26 mm) and high correlation coefficients (range: 0.53-1.00). Timing to complete virtual superimposition techniques ranged between a few seconds up to 40 min. CONCLUSIONS: Voxel-based superimposition protocols presented the highest accuracy and reproducibility. Moreover, superimposition protocols that used automated processes and involved only one software were the most efficient.

Management of excessive gingival display using botulinum toxin type A: a descriptive study.

Botulinum toxin is a protease used by the bacterium Clostridium botulinum that causes chemical denervation of skeletal muscles, producing a temporary weakening of muscle activity. Despite having a transitory effect, the application of botulinum toxin has been identified as an alternative for correcting an excessive gingival display (EGD). However, studies evaluating the maintenance of long-term results of botulinum toxin remain scarce. This study aimed to evaluate the effectiveness and duration of botulinum toxin type A in the treatment of anterior EGD. Botulinum toxin Type A was applied to 15 patients with EGD. The measurement was performed in triplicate, using a Castro Viejo dry point compass, between the central cervical portion of the upper lateral incisors to the lower portion of the upper lip, bilaterally. The measurements were performed before the application of the toxin and repeated on days 7, 14, 90, 120, and 180 after the procedure. The data were analyzed using repeated-measures ANOVA, followed by a Bonferroni. There was a statistically significant reduction between the measurements performed on the Baseline and seven days after the application of the botulinum toxin. After 180 days, approximately one-quarter of the patients in the sample did not presented EGD. Mild adverse effects were reported by 46.7% of the patients. The use of botulinum toxin type A was effective to treat EGD. After 180 days, it was still possible to observe a significant effect compared to the initial gingival exposure.

Facial Nerve Palsy Associated With Orthognathic Surgery.

The authors report a 25-year-old female who presented facial palsy after undergoing bimaxillary orthognathic surgery for retrognathism correction. Orthognathic surgery is a procedure used to treat dentofacial deformities which aims to achieve an adequate relationship between dental archs, improving function (such as chewing, breathing, and speaking) and facial aesthetics. Even though there are some complications that can occur during the intraoperative and postoperative periods like bleeding, tooth, soft-tissue damage, nerve damage, bad split, infection, and nonunion, facial nerve injuries are considered rare complications after this kind of surgical procedure. Despite being uncommon, rarely described, transient, and spontaneously resolved in almost all patients, facial nerve palsy is one of the most serious complications because it directly affects patient's quality of life and social interaction.

Odontoma composto associado a incisivo central superior impactado: relato de caso / Compound odontoma associated with impacted upper central incisor: case report

Introdução: o odontoma é um tipo de tumor do epitélio odontogênico com ectomesênquima, podendo estar relacionado à presença de dentes não irrompidos. O tratamento consiste em excisão cirúrgica da lesão. Nor-malmente, dentes impactados são assintomáticos, sendo descobertos em radiografias de rotina. A impactação é causada por fatores sistêmicos ou etiológicos locais. Objetivo: reportar um caso clínico de uma criança com impactação dentária de um incisivo central superior esquerdo associado a um odontoma, enfatizando e discutindo a técnica cirúrgica e o planejamento realizado. Relato de caso: paciente de 13 anos de idade, do gênero feminino, com a não erupção do incisivo central superior esquerdo, ao exame clínico, apresentou ausência clínica do dente 21, persistência do dente 61 e um discreto aumento de volume entre os elementos 61 e 22. Foi solicitada uma tomografia computadorizada de feixe cônico (cone beam) da região, na qual se diagnosticou a presença de uma massa radiopaca envolta por um halo radiolúcido sugestivo de odontoma composto, alterando a posição e impedindo a erupção do dente 21, que se encontrava em posição transal-veolar. O plano de tratamento proposto foi remoção cirúrgica do odontoma e tracionamento do dente não irrompido. Conclusão: a remoção cirúrgica de patologias associadas e as manobras referentes aos dentes envolvidos devem ser realizadas no momento mais oportuno e com adequado planejamento, evitando lesões a estruturas nobres e permitindo, assim, um processo de reparo adequado e uma completa restauração da saúde bucal do paciente. (AU)

Introduction: Odontoma is a type of tumor of the odontogenic epithelium with ectomesenchyme and it may be related to the presence of unerupted teeth. The treatment consists of surgical excision of the lesion. Usually, unerupted teeth are asymptomatic and discovered in routine radiographs. Impaction is caused by local systemic or etiological factors. Objective: The present study aims to report a clinical case of a child with an impacted upper central incisor associated with an odontoma, highlighting and discussing the surgical technique and treatment planning. Case report: A 13-year-old female patient without eruption of the left upper central incisor. After clinical examination, the absence of tooth 21, persistence of tooth 61, and a discrete volume increase between elements 61 and 22 were observed. A cone beam computed tomography of the region was requested, which diagnosed the presence of a radiopaque mass involved by a radiolucent halo suggestive of compound odontoma. This condition changed the position and prevented the eruption of tooth 21, which was found in a transalveolar position. The treatment plan proposed was the surgical removal of the odontoma and orthodontic traction of the unerupted tooth. Conclusion: The surgical removal of associated pathologies and maneuvers related to the teeth involved should be performed in a timely manner, with adequate planning, preventing lesions in noble structures, thus allowing an adequate repair process and a complete restoration of the oral health of the patient. (AU)

Perfil epidemiológico dos pacientes e dos atendimentos realizados no ambulatório de exodontia (FO-UFRGS) / Epidemiological survey of patients seeking dental care in the tooth extraction outpatient clinic (FO-UFRGS)

Objetivo: Realizar um levantamento epidemiológico dos pacientes que buscaram atendimento no ambulatório de Exodontia da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul (FO-UFRGS).Métodos: Estudo descritivo retrospectivo no qual foram reunidos e tabulados 1905 relatórios cirúrgicos preenchidos pelos alunos da graduação nas atividades referentes à disciplina de Exodontia, entre os anos de 2011 e 2015.Resultados: Os pacientes eram na maioria mulheres, entre 30 e 59 anos, cor de pele branca, com ensino fundamental incompleto e renda familiar entre 2 e 3 salários mínimos, 30,9% dos pacientes relatavam fumar e 27,8% disseram consumir bebidas alcoólicas pelo menos uma vez por semana. Quanto à história clínica, 24,4% dos pacientes relataram sofrer de hipertensão, 7,9% eram diabéticos. Em relação aos procedimentos, 24,9% estavam indicados por serem restos radiculares, 9% dos procedimentos foram suspensos, sendo a hipertensão a principal razão para tal (42,6%). Em 59,8% dos procedimentos não houve nenhum tipo de complicação pós-operatória. Conclusão: A partir dos dados obtidos foi possível conhecer o perfil epidemiológico e a situação de saúde da população atendida, identificando suas principais necessidades, fornecendo informações estratégicas para a organização e qualificação do serviço. (AU)

Aim: To conduct an epidemiological study of patients seeking dental care in the Tooth Extraction Outpatient Clinic, School of Dentistry, Federal University of Rio Grande do Sul (FO-UFRGS). Methods: This research was a retrospective descriptive study on 1,905 surgical reports filled out by undergraduate students during the activities related to the Exodontics (Tooth Extraction) classes held between 2011 and 2015.Results: Patients were mostly women from 30 to 59 years of age, white, with an incomplete elementary school education, and a household income between 2 and 3 minimum salaries; 30.9% of the patients claimed to be smokers and 27.8% reported that they consumed alcohol at least once a week. In relation to the clinical history, 24.4% of the patients reported suffering from hypertension, and 7.9% were diabetic. Regarding the procedures, 24.9% had been referred due to the existence of root fragments; in 9% of the cases, procedures were suspended, mainly due to hypertension (42.6%). In 59.8% of the procedures, no postoperative complications were observed.Conclusion:From the obtained data, it was possible to access the epidemiological profile and the health status of the population who received dental care, identifying their main needs and providing strategic information for the organization and qualification of the service and the health care of these patients. (AU)

Changes in Cervical Lordosis After Orthognathic Surgery in Skeletal Class III Patients.

The purpose of this study was to evaluate cervical lordosis and head posture changes using lateral cephalographs after bimaxillary orthognathic surgery for mandibular prognatism by null hypothesis. Twenty-five patients with skeletal class III dentofacial deformities (10 men, 15 women; mean age, 29.28 ±â€Š8.23 years; range 18-48 years) were included in this prospective clinical study. Lateral cephalographs were taken in natural head position (NHP) 2 weeks before and 6 months after orthognathic surgery. The reproducibility of the radiographer's technique of taking radiographs in NHP was investigated using a photographic method and found to be acceptable. All measurements for cervical lordosis (CV1/CV2; CV3/CV7; CV1/CV7), head posture (NSL/OPT; NSL/VER), and other cephalometric values (NSL/Go-Gn; NSL/OCL; Overjet) were repeated 3 times by the same blinded investigator at 2-week intervals and the average values of the 3 measurements were calculated to use in statistical analysis. Intraclass correlation coefficients (ICC) ranged between 0.996 and 1.000, demonstrating a high reliability of the measures. Statistically significant differences were found for CV3/CV7 (P = 0.006) and CV1/CV7 (P = 0.005) and no significant differences were identified in head posture for both cranio-cervical and cranio-vertical angles. The null hypothesis was rejected. Orthognathic surgery resulted in significant cervical lordosis extension, and a tendency for head extension could also be observed.

Postural Assessment in Class III Patients Before Orthognathic Surgery.

PURPOSE: To determine the postural characteristics of patients with Class III dentofacial deformities before orthognathic surgery by photogrammetry using SAPO postural assessment software. MATERIALS AND METHODS: This was a cross-sectional study. Eligible participants were adult patients who had an indication for orthognathic surgery to correct skeletal Class III dentofacial deformities and were undergoing orthodontic preparation for surgery. Patients were recruited at the outpatient clinic for dentofacial deformities of the authors' institution from March to November 2015. Postural assessment was performed by photogrammetry based on anterior, posterior, and lateral images, which were analyzed using SAPO software. RESULTS: The sample consisted of 40 patients with a mean age of 28.7 years; 55% were men. Postural changes were found in most anatomic structures, and the main changes were anterior displacement of the center of gravity (sagittal plane asymmetry, 43.77%) and a tendency to left lateral deviation (frontal plane asymmetry, -3.89%). The anterior view showed a pattern of head tilt to the left (measured value minus reference value [Δ], -0.22), elevation of the left acromion (Δ, 2.31), elevation of the right anterior superior iliac spine (Δ, -0.56), right knee with genu varum (Δ, 1.25), and left knee with genu valgum (Δ, -1.55). The posterior view displayed scapular asymmetry with abduction of the right scapula (Δ, 7.54) and valgus foot deformity (Δright, 8.35; Δleft, 11.60). The lateral view depicted decreased cervical lordosis (Δright, 22.63; Δleft, 19.98), pelvic anteversion (Δright, -0.56; Δleft, -0.26), and genu flexum at the right (Δ, 6.85) and left (Δ, 4.40) knees. Twenty-seven patients (67.5%) reported temporomandibular joint pain. CONCLUSIONS: Postural assessment by photogrammetry showed that most anatomic structures were outside the normal range in patients with skeletal Class III dentofacial deformities before orthognathic surgery. These results suggest that dentofacial abnormalities can lead to postural disorders in this population.

Perfil sociodemográfico, epidemiológico e comportamental dos pacientes atendidos no ambulatório de exodontia da FO-UFRGS e a efetividade dos atendimentos realizados / Sociodemographic, epidemiological and behavioral profile in patients attended at the tooth extraction outpatient clinic, School of Dentistry, UFRGS, and the effectiveness of dental care provided

Objetivo: Identificar o perfil sociodemográfico, epidemiológico, comportamental e de utilização dos serviços dos pacientes atendidos no ambulatório de exodontia da Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul (FO-UFRGS), bem como os principais tipos de procedimentos, técnicas e condutas empregadas e intercorrências trans/pós-operatórias mais comuns. Material e Métodos: Estudo descritivo retrospectivo. Foram tabulados 877 relatórios cirúrgicos preenchidos pelos alunos da graduação nas atividades das disciplinas de Exodontia e Anestesiologia e Introdução à Exodontia, entre 2011/2 e 2013/1. As informações foram analisadas pelo programa Software Package for Social Sciences (SPSS for Windows, version 18.0, SPSS Inc, Chicago, IL), sendo calculadas as distribuições de frequência das variáveis investigadas. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade. Resultados: Os pacientes eram, na maioria, mulheres, entre 30-59 anos, cor de pele branca, ensino fundamental incompleto, além de possuírem uma renda familiar entre 2 e 3 salários mínimos. Em relação aos hábitos comportamentais, 34,4% dos pacientes relatavam fumar e 31,1% disseram consumir bebidas alcoólicas pelo menos uma vez por semana. Quanto à história clínica, 25,1% dos pacientes relataram sofrer de hipertensão, 33,3% eram diabéticos ou tinham algum parente próximo com diabetes, 36,3% estavam em tratamento médico e 54,8% utilizavam um ou mais medicamentos. Em relação aos procedimentos, 39,5% estavam indicados por serem restos radiculares, sendo que em 30,1% dos casos os pacientes já chegavam com a queixa principal de extração. Conclusão: Foi possível conhecer o perfil sociodemográfico da população estudada ­ sexo feminino, 30-59 anos, cor de pele branca, ensino fundamental incompleto, renda familiar entre 2-3 salários mínimos ­ e sua situação de saúde (dados epidemiológicos-comportamentais). A maior parte dos pacientes não fumava, não consumia bebidas alcoólicas e não sofria de hipertensão ou diabetes, porém relatou estar usando um ou mais medicamentos. As intercorrências mais comuns foram hemorragia e lipotímia.(AU)

Aim: To identify the sociodemographic, epidemiological, behavioral and service utilization profiles of the patients who received dental care at the Tooth Extraction Outpatient Clinic, School of Dentistry, Federal University of Rio Grande do Sul (FO-UFRGS), as well as the main types of procedures, together with the most commonly employed procedures, techniques, and conducts, and the most common trans and postoperative complications. Methods: This was a retrospective descriptive study, in which 877 surgical reports, filled out by undergraduate students during the activitiesrelated to the Exodontics and Anesthesiology, as well as Intro to Exodontics, classes between the second semester of 2011 and the first semester of 2013, were gathered and tabulated. The collected data were analyzed using Software Package for Social Sciences (SPSS for Windows, version 18.0, SPSS Inc, Chicago, IL), calculating the frequency distribution of investigated variables. This study was approved by the University's Research Ethics Committee. Results: Patients were mostly women, from 30 and 59 years of age, of white ethnicity, with an incomplete elementary school education, and a household income of between 2 and 3 minimum wages. Regarding behavioral habits, 34.4% of the patients reported being smokers and 31.1% reported alcohol consumption at least once a week. Regarding the clinical history, 25.1% of patients reported suffering from hypertension, 33.3% were diabetic or had a close relative with diabetes, 36.3% were under medical treatment, and 54.8% used one or more types of medicine. Regarding the procedures, 39.5% were indicated because they were root fragments, while 30.1% of the patients had arrived with the main complaint of tooth extraction. Conclusion: It was possible to access the sociodemographic profile ­ women, between 30-59 years of age, of white ethnicity, incomplete elementary school education, household income between 2 and 3 minimum wages ­ and the health status of the population (epidemiological and behavioral data). Most of the patients were not smokers, did not consume alcoholic beverages, and did not suffer from hypertension or diabetes, but they did report the use of one or more types of medicine. The most common complications were bleeding and fainting.(AU)