Artificial intelligence as a prediction tool for orthognathic surgery assessment.

INTRODUCTION: An ideal orthodontic treatment involves qualitative and quantitative measurements of dental and skeletal components to evaluate patients' discrepancies, such as facial, occlusal, and functional characteristics. Deciding between orthodontics and orthognathic surgery remains challenging, especially in borderline patients. Advances in technology are aiding clinical decisions in orthodontics. The increasing availability of data and the era of big data enable the use of artificial intelligence to guide clinicians' diagnoses. This study aims to test the capacity of different machine learning (ML) models to predict whether orthognathic surgery or orthodontics treatment is required, using soft and hard tissue cephalometric values. METHODS: A total of 920 lateral radiographs from patients previously treated with either conventional orthodontics or in combination with orthognathic surgery were used, comprising n = 558 Class II and n = 362 Class III patients, respectively. Thirty-two measures were obtained from each cephalogram at the initial appointment. The subjects were randomly divided into training (n = 552), validation (n = 183), and test (n = 185) datasets, both as an entire sample and divided into Class II and Class III sub-groups. The extracted data were evaluated using 10 machine learning models and by a four-expert panel consisting of orthodontists (n = 2) and surgeons (n = 2). RESULTS: The combined prediction of 10 models showed top-ranked performance in the testing dataset for accuracy, F1-score, and AUC (entire sample: 0.707, 0.706, 0.791; Class II: 0.759, 0.758, 0.824; Class III: 0.822, 0.807, 0.89). CONCLUSIONS: The proposed combined 10 ML approach model accurately predicted the need for orthognathic surgery, showing better performance in Class III patients.

Is three-piece maxillary segmentation surgery a stable procedure?

Objective: : The number of three-piece maxillary osteotomies has increased over the years; however, the literature remains controversial. The objective of this study was to evaluate the skeletal stability of this surgical modality compared with that of one-piece maxillary osteotomy. Methods: : This retrospective cohort study included 39 individuals who underwent Le Fort I maxillary osteotomies and were divided into two groups: group 1 (three pieces, n = 22) and group 2 (one piece, n = 17). Three cone-beam computed tomography scans from each patient (T1, pre-surgical; T2, post-surgical; and T3, follow-up) were used to evaluate the three-dimensional skeletal changes. Results: : The differences within groups were statistically significant only for group 1 in terms of surgical changes (T2-T1) with a mean difference in the canine region of 3.09 mm and the posterior region of 3.08 mm. No significant differences in surgical stability were identified between or within the groups. The mean values of the differences between groups were 0.05 mm (posterior region) and -0.39 mm (canine region). Conclusions: : Our findings suggest that one- and three-piece maxillary osteotomies result in similar post-surgical skeletal stability.

Assessment of the bone thickness of the palate on cone-beam computed tomography for placement of miniscrew-assisted rapid palatal expansion appliances.

INTRODUCTION: The correction of maxillary transverse discrepancy is achieved by means of rapid maxillary expansion, which may be performed by conventional or surgically-assisted rapid maxillary expansion, and more recently, by miniscrew-assisted rapid palatal expansion (MARPE). This study assessed the bone thickness of the palate on cone-beam computed tomography (CBCT) images for placement of mini-implants and anchorage of MARPE. METHODS: The sample consisted of 223 CBCT scans from patients of both genders (137 females and 86 males) aged ≥18 years. By using the Image Studio software (Anne Solutions, São Paulo, Brazil), measurements of the bone thickness of the palate were performed bilaterally, as follows: in the axial plane, the bone thicknesses were determined in the anterior region (distal face of the first premolars) and the posterior region (distal face of the first molars), at 3 mm and 6 mm laterally to the midpalatal suture. So in the sagittal plane, the bone thicknesses of the palate were measured in these placements from the palatal cortical to the nasal floor cortical in the anterior region at 30°, 45°, and 90°. In the posterior region, the bone thickness was determined only at 90°. The statistical tests used were the Kruskal-Wallis H test (analysis of variance on ranks) with Dunn's post-hoc test and Mann-Whitney U test (P <0.05). RESULTS: The bone thickness of the palate in the anterior region varied from 8.57 mm in women to 11.28 mm in men at 3 mm from the midpalatal suture and from 7.99 mm in women to 10.47 mm in men at 6 mm for 30°; from 6.35 mm in women to 9.28 mm in men at 3 mm from the midpalatal suture and from 6.20 mm in women to 8.88 mm in men at 6 mm for 45°; from 4.51 mm in women to 6.85 mm in men at 3 mm from the midpalatal suture and from 4.29 mm in women to 6.64 mm in men at 6 mm for 90°. In the posterior region, the bone thickness varied from 2.93 mm (3 mm from the suture) to 1.78 mm (6 mm from the suture) for women and from 3.24 mm (3 mm from the suture) to 1.99 mm (6 mm from the suture) for men. In general, the bone thickness of the palate is greater in the anterior region at 3 mm from the midpalatal suture at 30°. CONCLUSIONS: There was high variability in the bone thickness of the palate among patients and in different areas. Therefore, it is necessary to make an individualized diagnosis of the patient and manufacture the MARPE appliance carefully by performing a prior evaluation of the palatal bone thickness by means of CBCT to determine the ideal sites and inclinations for placement of mini-implants.

Craniofacial and airway morphology of individuals with oculoauriculovertebral spectrum.

OBJECTIVES: The objectives of this study were to characterize the craniofacial and airway morphology of oculo-auriculo-vertebral spectrum (OAVS) individuals using computed tomography (CT) examination. SETTING AND SAMPLE POPULATION: This sample included individuals in the age range from 5 to 14 years, consisted of a group of 18 OAVS individuals (12 females and 6 males), Pruzansky-Kaban1 IIB and III and by a paired control group matched by age and sex for comparison of morphometric and airway variables. MATERIALS AND METHODS: Through the CT examination, airway analysis was performed using Dolphin Imaging® Software, and seven morphometric measurements were performed to evaluate craniofacial morphology by Materialize Mimics® Software. To compare airway and morphometric variables, the control group was used. Student's t test and Mann-Whitney U test were performed to compare differences between the groups. RESULTS: Statistically significant differences were showed between the control and OAVS groups for the variables: total airway (TA) area, volume and MAA, RP area, RP volume, RP MAA, RG volume, RG MAA, total posterior height diff, Md incl and y-axis asymmetry. Pearson and Spearman's correlation showed mostly moderate correlations between Mand Occlusal canting AS with TA area and RP volume, Ax-Gn with TA area and Hy-C3 with TA volume. CONCLUSIONS: The OAVS's airway was altered and worse than the control group. Our results suggest that the contralateral side of OAVS individuals is unaffected; however, longitudinal assessments are needed to confirm it. Hyoid bone and postural measures play an important role in interpreting airway features of individuals with and without OAVS.

Can palatal splint improve stability of segmental Le Fort I osteotomies?

OBJECTIVES: The purpose of this study was to evaluate the influence of a palatal splint on stability in multi-segment maxillary osteotomies. SETTING AND SAMPLE POPULATION: Retrospective series of fifty-one adult patients, consecutively operated with bilateral sagittal split osteotomy (BSSO) and three-piece maxillary osteotomies, divided according to the use of a palatal splint (Group 1, n = 30) or no palatal splint (Group 2, n = 21). MATERIALS AND METHODS: Maxillary surgical casts (T1) and post-retention casts (T2), taken at least six months after discontinuation of orthodontic retention, were digitized (MicroScribe-3DX), measured and compared. Fifty-one landmarks were identified on the maxillary, transverse dimension changes and arch length were calculated. Longitudinal changes in all measurements were assessed by t test. RESULTS: Post-surgical transverse instability in group 1 ranged from 0.3 ± 0.4 to -1.3 ± 0.2 mm and was statistically significantly smaller than in group 2 that ranged from -1.0 ± 0.3 to -2.5 ± 0.5 mm. CONCLUSIONS: The use of a palatal splint after segmental Le Fort I maxillary osteotomy improved transverse stability in the posterior region. The post-surgical transverse instability occurred only between canine gingival points and thus suggesting no clinical relevance.

Expansão mandibular por distração osteogênica ­ relato de caso / Mandibular expansion by osteogenic distraction ­ case report

Introdução: As deficiências transversais mandibulares são comumente corrigidas com expansão ortodôntica dentoalveolar, vestibularizações dentárias, desgastes interproximais e/ou extração dentária. Nesse contexto, a distração osteogênica da sínfise mandibular (DOSM) tem sido proposta como uma boa opção de tratamento. Objetivo: Relatar o caso clínico de um paciente com mandíbula atrésica tratado com DOSM, enfatizando a etapa ortodôntica pré-cirúrgica e a cirurgia propriamente dita. Resultados: Essa modalidade de tratamento aumentou significativamente a largura mandibular, dispensando a necessidade de tratamento ortodôntico com extrações. Conclusão: A distração osteogênica mediana transversal de mandíbula é uma técnica cirúrgica efetiva para correção de deficiências mandibulares transversais severas, em que os resultados obtidos exclusivamente com Ortodontia são limitados. Essa técnica permite movimentos esqueléticos amplos com um mínimo de recidiva por expandir concomitante o osso e os tecidos moles. (AU)

Introduction: Mandibular transversal deficiencies are commonly corrected with dentoalveolar orthodontic expansion, dental vestibularizations, interproximal wear and/or tooth extraction. In this context, the osteogenic distraction of the mandibular symphysis (ODMS) has been proposed as a good treatment option. Objective: To report the clinical case of a patient with atresic mandible treated with ODMS emphasizing the pre-surgical orthodontic stage and the surgery itself. Results: This modality of treatment significantly increased the mandibular width, dispensing the need for orthodontic treatment with extractions. Conclusion: Mandible transverse medial osteogenic distraction is an effective surgical technique for correction of severe transverse mandibular deficiencies, in which results obtained exclusively with orthodontics are limited. This technique allows large skeletal movements with minimal recurrence by expanding concomitantly the bone and soft tissues.(AU)

From ideal occlusion to dentofacial deformity and back to ideal: an osteochondroma treatment with lingual orthodontics.

This original case report describes the morphologic changes caused by a mandibular condylar osteochondroma (OC) on a female patient and its treatment. The changes were identified by comparing her final records from a previous orthodontic treatment, without the presence of OC, to records taken before a second treatment, with a developed OC. The diagnostics and treatment for the OC and its consequences were described and discussed in this paper. Treatment included orthodontics with a lingual appliance, low condylectomy on the affected side, high condylectomy on the contralateral side, bilateral disc repositioning and orthognathic surgery. It was concluded that the OC caused a Class III subdivision malocclusion, midline deviation and an edge-to-edge bite on the left side, a cant of the occlusal plane on the Z-axis and a deviation of the pogonion to the left. Treatment was successful and stable long term (36 months) with good occlusal, aesthetical and functional results.

Orthodontic Traction of Impacted Canine Using Cantilever.

The impaction of the maxillary canines causes relevant aesthetic and functional problems. The multidisciplinary approach to the proper planning and execution of orthodontic traction of the element in question is essential. Many strategies are cited in the literature; among them is the good biomechanical control in order to avoid possible side effects. The aim of this paper is to present a case report in which a superior canine impacted by palatine was pulled out with the aid of the cantilever on the Segmented Arch Technique (SAT) concept. A 14.7-year-old female patient appeared at clinic complaining about the absence of the upper right permanent canine. The proposed treatment prioritized the traction of the upper right canine without changing the occlusion and aesthetics. For this, it only installed the upper fixed appliance (Roth with slot 0.018), opting for SAT in order to minimize unwanted side effects. The use of cantilever to the traction of the upper right canine has enabled an efficient and predictable outcome, because it is of statically determined mechanics.

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.

Three-dimensional dental arch changes of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusion.

INTRODUCTION: This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods. METHODS: Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches. RESULTS: During orthodontic preparation, the maxillary and mandibular transverse dimensions measured at the premolar regions were increased and maintained throughout the follow-up period. Intercanine width was increased only in the upper arch during orthodontic preparation. Maxillary arch length was reduced during orthodontic finalization, only. Upper and lower arch depths were stable in the study periods. Differences between changes in centroid and gingival points suggested that upper and lower premolars buccaly proclined during the pre-surgical period. CONCLUSIONS: Maxillary and mandibular dental arches presented transverse expansion at premolar regions during preoperative orthodontic preparation, with a tendency towards buccal tipping. The transverse dimensions were not altered after surgery. No sagittal or vertical changes were observed during the follow-up periods.

Three-dimensional dental arch changes of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusion

INTRODUCTION: This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods. METHODS: Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches. RESULTS: During orthodontic preparation, the maxillary and mandibular transverse dimensions measured at the premolar regions were increased and maintained throughout the follow-up period. Intercanine width was increased only in the upper arch during orthodontic preparation. Maxillary arch length was reduced during orthodontic finalization, only. Upper and lower arch depths were stable in the study periods. Differences between centroid and gingival changes suggested that upper and lower arch premolars buccaly proclined during the pre-surgical period. CONCLUSIONS: Maxillary and mandibular dental arches presented transverse expansion at premolar regions during preoperative orthodontic preparation, with a tendency towards buccal tipping. The transverse dimensions were not altered after surgery. No sagittal or vertical changes were observed during the follow-up periods. .

INTRODUÇÃO: esse estudo avaliou as alterações tridimensionais ocorridas na morfologia das arcadas dentárias de pacientes submetidos ao tratamento ortodôntico-cirúrgico para a correção da má oclusão de Classe II, em três períodos distintos: (T1) modelos iniciais, (T2) modelos pré-cirúrgicos imediatos (de 1 a 15 dias antes da cirurgia) e (T3) modelos pós-cirúrgicos (mínimo de 6 meses após a remoção do aparelho ortodôntico). MÉTODOS: pontos previamente demarcados em cada modelo foram digitalizados por meio do digitalizador tridimensional MicroScribe-3DX, cujas coordenadas, armazenadas em planilhas do programa Excel, deram origem a valores que possibilitaram a avaliação da largura, comprimento e profundidade das arcadas dentárias. RESULTADOS: durante o preparo ortodôntico, houve aumentos nas distâncias transversais superiores e inferiores medidas na região de pré-molares que se mantiveram no período total de acompanhamento. Apenas a distância intercaninos superior apresentou alterações de aumento durante o preparo ortodôntico, assim como a largura da arcada superior, que diminuiu durante a fase de finalização. A profundidade de ambas as arcadas manteve-se estável nas fases avaliadas. Diferenças entre as mudanças dos pontos centroide e gengival sugerem que os pré-molares superiores e inferiores inclinaram para vestibular durante o preparo ortodôntico pré-cirúrgico. CONCLUSÇÕES: conclui-se que as arcadas dentárias superiores e inferiores sofreram expansão transversal na região de pré-molares durante o preparo ortodôntico pré-cirúrgico, com tendência à inclinação vestibular de todos os dentes posteriores. Após a cirurgia, as dimensões transversais ...

Estabilidade oclusal a longo prazo de Classe II, divisão 1, após tratamento com extração de pré-molares / Long-term occlusal stability of Class II division 1 after treatment with premolars extraction

Pacientes buscam mudanças estéticas e funcionais quando procuram tratamento ortodôntico e esperam que a oclusão permaneça estável. A estabilidade da oclusão é um dos objetivos do ortodontista, entretanto, mudanças das relações dentárias a longo prazo podem ocorrer, levando a uma recidiva do tratamento. Os dentes e a forma dos arcos tendem a voltar para a forma original, sendo a fase de contenção importante após a remoção do aparelho, mesmo depois de alguns anos de pós-tratamento. Este artigo aborda a apresentação de um caso clínico de Classe II, divisão 1, tratado com extração de pré-molares, analisando sua estabilidade a longo prazo...

Patients are looking for esthetic and functional changes when seeking orthodontic treatment and expect the remaining of a stable occlusion. Occlusion stability is one of the goals of the orthodontist; however, dental relationships changes in long-term can occur leading to a relapse of the treatment. Teeth and shape of arches tend to return to the original form, been the retention phase important after the appliance removal, even after several years of post-treatment. This article approaches a submission of a clinical case of Class II division 1 treated with extraction of premolars analyzing its long-term stability...

Systematic review: craniocervical posture and craniofacial morphology.

The purpose of this study was to investigate the published evidence regarding the association between head and cervical posture and craniofacial morphology. An electronic search was conducted in PubMed, Medline, Embase, Scopus, and Cochrane databases up to 23 March 2012. Abstracts that seemed to correspond with the goals of this review were selected by a consensus between two independent reviewers. The original articles were retrieved and evaluated to ensure they match the inclusion criteria. Only articles that directly compared head and/or cervical posture with craniofacial morphology were included. A total of 84 articles were found of which 12 matched all inclusion criteria. Detailed analysis of the methodology in selected articles revealed quality scores ranging from 'weak' to 'moderate'. Nine articles were cross-sectional studies, whereas only three were longitudinal studies. The findings of selected articles were linked together in order to clarify the evidence on sagittal and vertical craniofacial features as well as growth prediction regarding different postures of the head and neck. On the basis of the data obtained from the literature, significant associations were found between variables concerning head and cervical posture and craniofacial morphology. However, the results of this systematic review suggest that such associations should be carefully interpreted, considering that correlation coefficients found ranged from low to moderate. Moreover, conflicting results were observed regarding some postural variables. Further longitudinal studies are required to elucidate the relationship between the development of craniofacial morphology and functional aspects of head and cervical posture.

Photographic assessment of cephalometric measurements.

OBJECTIVE: To investigate the relationship between craniofacial measurements obtained from cephalometric radiographs and analogous measurements from profile photographs. MATERIALS AND METHODS: Lateral cephalograms and standardized facial profile photographs were obtained from a sample of 123 subjects (65 girls, 58 boys; age 7-12 years). Intraclass correlation coefficients (ICCs) were calculated from repeated photographic measurements to evaluate method reliability. Analogous cephalometric and photographic measurements were compared to assess Pearson correlation coefficients. Linear regression analyses were conducted between the measurements that achieved correlation coefficients greater than r  =  0.7. RESULTS: The reliability of the photographic technique was satisfactory. Most measurements showed ICCs above 0.80 and highly significant correlations (P ≤ .001) with cephalometric variables. Among all measurements used, the A'N'B' angle was the most effective in explaining the variability of its analogous cephalometric, mainly for female subjects (r(2)  =  0.80). The FMA' angle showed the best results for vertical assessment (r(2)  =  0.65). CONCLUSIONS: The photographic method has proven to be a repeatable and reproducible tool provided that a standardized protocol is followed. Therefore, it may be considered a feasible and practical diagnostic alternative, particularly if there is a need for a low-cost and noninvasive method.

Análise de Bolton: uma proposta alternativa para a simplificação de seu uso / Bolton analysis: an alternative proposal for simplification of its use

INTRODUÇÃO: as discrepâncias entre o tamanho mesiodistal dos dentes superiores e inferiores e seus efeitos sobre a oclusão têm sido relatados há muito tempo. O método proposto por Bolton para o diagnóstico de discrepância de tamanho dentário é, inegavelmente, um dos mais difundidos no meio ortodôntico, devido à sua relativa simplicidade. Entretanto, a aplicação desse método requer cálculos matemáticos e o uso de tabelas que, muitas vezes, inviabilizam a sua utilização durante a avaliação clínica. OBJETIVO: avaliar o método proposto por Wolford, que não requer o uso de tabelas, como alternativa ao método tradicional de Bolton. MÉTODOS: a amostra foi composta por 90 pares de modelos dentários iniciais de pacientes adultos, com diferentes más oclusões. A proporção entre os dentes inferiores e superiores foi calculada para cada paciente, resultando na obtenção de dois índices (a razão total e a razão anterior). Os índices foram obtidos por meio do método originalmente proposto por Bolton e por um método alternativo, composto por duas fórmulas (uma simplificada e a variação da mesma), que foram analisadas separadamente. RESULTADOS: comparadas ao método de Bolton, as fórmulas simplificadas mostraram uma tendência de superestimar as discrepâncias dentárias inferiores (total e anterior), embora em pequena proporção. CONCLUSÕES: ambas as fórmulas do método alternativo podem ser utilizadas em substituição ao método tradicional, uma vez que mostraram diferenças médias menores que 0,58mm quando comparadas ao método de Bolton, não apresentando, portanto, significância clínica.

INTRODUCTION: Mesiodistal size discrepancies of upper and lower teeth and their effect on occlusion have been related. Bolton's method for tooth size discrepancies is, undeniably, one of the most commonly-used methods in orthodontics because of its simplicity. However, the application of this method requires mathematical calculations and use of tables, which often prevents its clinical use. PURPOSE: Evaluate an alternative method for Bolton's analysis proposed by Wolford that does not require table information. MATERIAL AND METHODS: The sample was composed of 90 initial dental casts of adult patients, with different malocclusions. The ratio between the sum of widths of maxillary and mandibular teeth was calculated for each patient, resulting in the attainment of two indices: The overall ratio and the anterior ratio. Indices were calculated by Bolton's method and by an alternative method, using two different formulas (one simplified and a variation of the same formula) that were separately analyzed. RESULTS: In comparison with Bolton's method, the Simplified Formulas demonstrated a slight trend towards an overestimation of the inferior dental discrepancies (overall and anterior). CONCLUSION: Both formulas employed for the alternative method may be used to substitute the traditional method, since each demonstrated, on average, differences of less than 0.58 mm when compared with Bolton's method and no clinical significance.

Estabilidade sagital da condiloplastia associada à cirurgia ortognática para o tratamento do osteocondroma mandibular / Post surgical stability of conservative condylectomy for treatment of osteochondroma of the mandibular condyle

O propósito deste estudo foi avaliar alterações das estruturas esqueléticas,dentárias e a estabilidade da técnica da condiloplastia, reposicionamento do disco articular e cirurgia ortognática como tratamento integral do paciente portador de osteocondroma condilar. Foram analisadas telerradiografias laterais de 15 pacientes (12 femininos, três masculinos), idade média de 32,3 anos (entre, 13 e 56 anos), com osteocondroma condilar ativo unilateral consecutivamente tratado. Os pacientes foram submetidos à condiloplastia,reposicionamento do disco articular e cirurgia ortognática simultânea. O acompanhamento pós-cirúrgico foi de 19 meses em média. As telerradiografias da amostra foram tomadas em três intervalos: pré-cirúrgico (T1). pós-cirúrgico imediato (T2) e pós-cirúrgico tardio (T3) e avaliadas por meio da análise cefalométrica. No pós-cirúrgico imediato observou-se diminuição da inclinação do plano oclusal em -2,85° ± 4,53°, o complexo maxilomandibulargirou no sentido anti-horário com avanço do ponto Me em 5,32 ± 5,58 mm, pogonio 4,99 ± 5,15 mm, ponto B 3,41 ± 4,18 mm e ponto A 1,00 ± 1,54 mm. O acompanhamento em longo prazo mostrou que houve pequenas mudanças na sobremordida (-0,56 ± 0,51mm) e no ângulo SNGoMe (0,93° ± 1,53°). O ponto Me mostrou instabilidade horizontal de -1,21 ± 1,94 mm e o ponto ENP apresentou instabilidade vertical de -1,48 ± 1,67 mm. A proservação em longo prazo mostrou sólida estabilidade dentoesquelética na maioria dasáreas estudadas com instabilidade isolada horizontal do ponto Me e vertical do ponto ENP que não foram relacionadas com a recidiva do tumor.

The aim of this study was to evaluate the stability of the conservative condylectomy technique and articular disc repositioning as the surgical treatment approach for management of mandibular condylar osteochondroma, with appropriate Orthognathicsurgery. Fifteen patients (12 females and 3 males), average age of 32.3 years (range, 13 to 56 yeers), with unilateral active osteochondroma of the mandibular condyle were analyzed. All patients underwent conserva tive condylectomy, recontouring of the remaining condylarneck stump and articular disc repositioned and indicated orthognatic surgical procedures. Average post surgical follow-up was 19 months. Each patient's lateral cephalograms weretraced at 3intervals (presurgery, immediate post surgery and long-term follow-up). Immediate after surgery the oclusal plane angle decreased -2.8 ± 4.50, the maxillomandibular complexrotated counter-clockwise with advancement at menton 5.3 ± 5.6 mm, pogonion 5.0 ± 5.1 mm, B point 3.4 ± 4.2 mm and A point 1.0 ± 1.5 mm. The long-term follow-up showedsigniticant changes in overbite (-0.6 ± 0.5 mm) and SNGoMe (0,93° ± 1,53°). Horizontally and vertically small instabilities occurred in Me (-1.21 s: 1.94 mm) and PNS (-1.48 ± 1.67mm) respectively. The treatment protocol studied produced counterclockwise rotation andmaxillofacial mandibular advancement. The long-term follow-up showed solid dental and skeletal stability with horizontal instability of Me and PNS in the vertical direction.

Sedação consciente: um recurso coadjuvante no atendimento odontológico de crianças não cooperativas / Conscious sedation: a backup resource for providing dental care to uncooperative children

Na prática clínica, existem muitas crianças imaturas e ansiosas ou pacientes com comportamento físico e/ou metal que não cooperam durante o tratamento odontológico. Como alternativa para o manejo desses pacientes utiliza-se a sedação consciente através da pré-medicação ou sedação com o óxido nitroso/ oxigênio. Essas técnicas, quando empregadas de maneira adequada, são válidas e seguras, obtendo-se ótimos resultados principalmente com crianças. Desta forma, o objetivo deste estudo é relatar os tipos de sedação conscientes mais utilizados em odontopediatria, como uma alternativa no tratamento odontológico de crianças com comportamento difícil.(AU)

In clinical practice, there are immature and anxious children or patients with physical and/or mental behavior who do not cooperate when dental care is being provided. Conscious sedation with premedication or sedation with nitrous oxide is used as an alternative for the management of these patients. When these techniques are used correctly they are considered valid and safe, and excellent results are commonly obtained, especially with children. Thus, the objective of this study is to report the types of conscious sedation most often used in pediatric dentistry as alternative sedation methods for providing dental treatment to children with difficult behavior.(AU)

Influência da cirurgia ortognática sobre a disfunção temporomandibular / Influence of orthognathic surgery on temporomandibular dysfunction

As disfunções temporomandibulares (DTM) abrangem diferentes sinais e sintomas da articulação temporomandibular (ATM), músculos mastigatórios e estruturas relacionadas. Embora os fatores oclusais apresentem baixa associação na caracterização da DTM, a relação da morfologia esquelética com a disfunção da ATM permanece obscura. Em más-oclusões severas com - discrepâncias esqueléticas, o tratamento ortodôntico combinado a cirurgia ortognática é muitas vezes necessário. A cirurgia ortognática e os seus efeitos sobre a DTM têm sido objeto de investigação de muitos estudos nas ultimas décadas. O propósito deste artigo foi revisar a literatura avaliando os resultados da cirurgia ortognática sobre os sinais e sintomas da DTM em pacientes ortodôntico-cirúrgicos, bem como analisar as evidências pertinentes a esse tema.

Temporomandibular dysfunctions (TMD) comprise different signs and symptoms of the temporomandibular joint (TMJ), masticatory muscles and related structures. Although the occlusal factors do not seem to play an important role in the TMD characterization, the relationship between the skeletal morphology and the TMJ dysfunctions remains uncertain. In the presence of severe malocclusion with skeletal discrepancies. orthodontic treatment combined with orthognathic surgery is recommended. Orthognathic surgery and its effects on the TMD have been object of investigation of a number of studies in the last decades. The objective of this study was both to review the literature by evaluating the effects of the orthognathic surgery on the signs and symptoms of the TMD in orthosurgical patients, and to analyze the evidences related to this issue.