Craniofacial morphology in patients with obstructive sleep apnea: cephalometric evaluation / Morfologia craniofacial em pacientes com apneia obstrutiva do sono: avaliação cefalométrica

Abstract Introduction: Obstructive sleep apnea is characterized by a reduced airflow through the upper airways during sleep. Two forms of obstructive sleep apnea are described: the central form and the obstructive form. The obstructive form is related to many factors, such as the craniofacial morphology. Objective: To evaluate the correlation between the morphology of the cranial base, of the mandible and the maxilla, and obstructive sleep apnea severity. Methods: Eighty-four patients, mean age of 50.4 years old; 73 males and 11 females with obstructive sleep apnea were enrolled in the present study. Patients with high body mass index and comorbidities were excluded. Lateral cephalograms and polysomnography were collected for each patient to evaluate the correlation between craniofacial morphology and obstructive sleep apnea severity. A Spearman's rho correlation test between cephalometric measurements and obstructive sleep apnea indexes was computed. Statistical significance was set at p < 0.05. Results: Patients with a severe obstructive sleep apnea presented a reduction of sagittal growth of both effective mandibular length and cranio-basal length. The mandibular length was the only variable with a statistical correlation with apnea-hypopnea index. Vertical dimension showed a weak correlation with the severity of obstructive sleep apnea. No correlation with maxillary sagittal dimension was shown. Conclusion: Obstructive sleep apnea severity may be correlated to mandibular and cranial base growth. Facial vertical dimension had no correlation with obstructive sleep apnea severity.

Resumo Introdução: A apneia obstrutiva do sono é caracterizada por um fluxo de ar reduzido nas vias aéreas superiores durante o sono. Duas formas de apneia são descritas: a forma central e a forma obstrutiva. A forma obstrutiva tem sido relacionada a vários fatores, como a morfologia craniofacial. Objetivo: Avaliar a correlação entre a morfologia da base do crânio, da mandíbula e da maxila e a gravidade da apneia obstrutiva do sono. Método: Foram incluídos no presente estudo 84 pacientes com apneia obstrutiva do sono, com média de 50,4 anos; 73 homens e 11 mulheres. Pacientes com alto índice de massa corpórea e comorbidades foram excluídos. Foram coletados cefalogramas laterais e polissonografia para cada paciente para avaliar a correlação entre a morfologia craniofacial e a gravidade da apneia. Foi computado o coeficiente de correlação de postos de Spearman (rho) entre medidas cefalométricas e índices de apneia obstrutiva do sono. A significância estatística foi estabelecida em p < 0,05. Resultados: Pacientes com apneia obstrutiva do sono grave apresentaram redução do crescimento sagital do comprimento mandibular efetivo e do comprimento crânio-basal. O comprimento mandibular foi a única variável que apresentou correlação estatística com o índice de apneia-hipopneia. A dimensão vertical mostrou uma fraca correlação com a gravidade da apneia. Não foi demonstrada correlação com a dimensão maxilar sagital. Conclusão: A gravidade da apneia obstrutiva do sono pode estar correlacionada ao crescimento da base mandibular e craniana. A dimensão facial vertical não apresentou correlação com a gravidade da apneia.

Craniofacial morphology in patients with obstructive sleep apnea: cephalometric evaluation.

INTRODUCTION: Obstructive sleep apnea is characterized by a reduced airflow through the upper airways during sleep. Two forms of obstructive sleep apnea are described: the central form and the obstructive form. The obstructive form is related to many factors, such as the craniofacial morphology. OBJECTIVE: To evaluate the correlation between the morphology of the cranial base, of the mandible and the maxilla, and obstructive sleep apnea severity. METHODS: Eighty-four patients, mean age of 50.4 years old; 73 males and 11 females with obstructive sleep apnea were enrolled in the present study. Patients with high body mass index and comorbidities were excluded. Lateral cephalograms and polysomnography were collected for each patient to evaluate the correlation between craniofacial morphology and obstructive sleep apnea severity. A Spearman's rho correlation test between cephalometric measurements and obstructive sleep apnea indexes was computed. Statistical significance was set at p < 0.05. RESULTS: Patients with a severe obstructive sleep apnea presented a reduction of sagittal growth of both effective mandibular length and cranio-basal length. The mandibular length was the only variable with a statistical correlation with apnea-hypopnea index. Vertical dimension showed a weak correlation with the severity of obstructive sleep apnea. No correlation with maxillary sagittal dimension was shown. CONCLUSION: Obstructive sleep apnea severity may be correlated to mandibular and cranial base growth. Facial vertical dimension had no correlation with obstructive sleep apnea severity.

Correlation between tooth size-arch length discrepancy and interradicular distances measured on CBCT and panoramic radiograph: an evaluation for miniscrew insertion.

INTRODUCTION: The selection of appropriate sites for miniscrew insertion is critical for clinical success. OBJECTIVES: The aim of the present study was to evaluate how interradicular spaces measured on panoramic radiograph compare with Cone-Beam Computed Tomography (CBCT), and how crowding can influence the presence of available space for miniscrew insertion, in order to define a new "safe zones" map. METHODS: A total of 80 pre-treatment panoramic radiographs and 80 CBCT scans with corresponding digital models were selected from the archives of the department of Dentistry, Aarhus University. Crowding was measured on digital models, while interradicular spaces mesial to the second molars were measured on panoramic radiographs and CBCTs. For panoramic radiographs, a magnification factor was calculated using tooth widths measured on digital models. Statistical analyses were performed to investigate the correlation between the amount of crowding and the available interradicular space. Visual maps showing the amount of interradicular spaces measured were drawn. RESULTS: The most convenient interradicular spaces are those between the second molar and the first premolar in the mandible, and between the central incisors in the maxilla. However, some spaces were revealed to be influenced by crowding. CONCLUSIONS: Calibration of panoramic radiographs is of utmost importance. Generally, panoramic radiographs underestimate the available space. Preliminary assessment of miniscrew insertion feasibility and the related selection of required radiographs can be facilitated using the new "safe zone" maps presented in this article.

Correlation between tooth size-arch length discrepancy and interradicular distances measured on CBCT and panoramic radiograph: an evaluation for miniscrew insertion

Abstract Introduction: The selection of appropriate sites for miniscrew insertion is critical for clinical success. Objectives: The aim of the present study was to evaluate how interradicular spaces measured on panoramic radiograph compare with Cone-Beam Computed Tomography (CBCT), and how crowding can influence the presence of available space for miniscrew insertion, in order to define a new "safe zones" map. Methods: A total of 80 pre-treatment panoramic radiographs and 80 CBCT scans with corresponding digital models were selected from the archives of the department of Dentistry, Aarhus University. Crowding was measured on digital models, while interradicular spaces mesial to the second molars were measured on panoramic radiographs and CBCTs. For panoramic radiographs, a magnification factor was calculated using tooth widths measured on digital models. Statistical analyses were performed to investigate the correlation between the amount of crowding and the available interradicular space. Visual maps showing the amount of interradicular spaces measured were drawn. Results: The most convenient interradicular spaces are those between the second molar and the first premolar in the mandible, and between the central incisors in the maxilla. However, some spaces were revealed to be influenced by crowding. Conclusions: Calibration of panoramic radiographs is of utmost importance. Generally, panoramic radiographs underestimate the available space. Preliminary assessment of miniscrew insertion feasibility and the related selection of required radiographs can be facilitated using the new "safe zone" maps presented in this article.

Resumo Introdução: a seleção de locais apropriados para a inserção de mini-implantes é crítica para o sucesso clínico. Objetivo: os objetivos do presente estudo foram avaliar as medições de espaços inter-radiculares feitas em radiografias panorâmicas e compará-las com as medições feitas com tomografia computadorizada de feixe cônico (TCFC), além de avaliar como o apinhamento pode influenciar na disponibilidade de espaços para inserção dos mini-implantes, no intuito de definir um novo mapa de "áreas seguras". Métodos: foram selecionadas, nos arquivos do departamento de Ortodontia da Aarhus University, 80 radiografias panorâmicas pré-tratamento e 80 imagens de TCFC com os modelos digitais correspondentes. O apinhamento foi medido nos modelos digitais, enquanto os espaços inter-radiculares mesiais aos segundos molares foram medidos nas radiografias panorâmicas e na TCFC. O fator de magnificação das radiografias panorâmicas foi calculado utilizando-se as larguras dentárias medidas nos modelos digitais. Análises estatísticas foram realizadas para investigar a correlação entre a quantidade de apinhamento e o espaço inter-radicular disponível. Foram desenhados mapas visuais mostrando a quantidade dos espaços inter-radiculares medidos. Resultados: os espaços inter-radiculares mais adequados são aqueles entre o segundo molar e o primeiro pré-molar inferior, e entre os incisivos centrais superiores. Porém, verificou-se que alguns espaços são influenciados pelo apinhamento. Conclusões: A calibração das radiografias panorâmicas é de suma importância, pois, geralmente, as radiografias panorâmicas subestimam o espaço disponível. A avaliação preliminar da viabilidade de inserção dos mini-implantes e a seleção das radiografias necessárias para isso podem ser facilitadas utilizando-se os novos mapas de "áreas seguras" aqui apresentados.

Average interradicular sites for miniscrew insertion: should dental crowding be considered?

OBJECTIVE: To define a map of interradicular spaces where miniscrew can be likely placed at a level covered by attached gingiva, and to assess if a correlation between crowding and availability of space exists. METHODS: Panoramic radiographs and digital models of 40 patients were selected according to the inclusion criteria. Interradicular spaces were measured on panoramic radiographs, while tooth size-arch length discrepancy was assessed on digital models. Statistical analysis was performed to evaluate if interradicular spaces are influenced by the presence of crowding. RESULTS: In the mandible, the most convenient sites for miniscrew insertion were in the spaces comprised between second molars and first premolars; in the maxilla, between first molars and second premolars as well as between canines and lateral incisors and between the two central incisors. The interradicular spaces between the maxillary canines and lateral incisors, and between mandibular first and second premolars revealed to be influenced by the presence of dental crowding. CONCLUSIONS: The average interradicular sites map hereby proposed can be used as a general guide for miniscrew insertion at the very beginning of orthodontic treatment planning. Then, the clinician should consider the amount of crowding: if this is large, the actual interradicular space in some areas might be significantly different from what reported on average. Individualized radiographs for every patient are still recommended.

Average interradicular sites for miniscrew insertion: should dental crowding be considered?

ABSTRACT Objective: To define a map of interradicular spaces where miniscrew can be likely placed at a level covered by attached gingiva, and to assess if a correlation between crowding and availability of space exists. Methods: Panoramic radiographs and digital models of 40 patients were selected according to the inclusion criteria. Interradicular spaces were measured on panoramic radiographs, while tooth size-arch length discrepancy was assessed on digital models. Statistical analysis was performed to evaluate if interradicular spaces are influenced by the presence of crowding. Results: In the mandible, the most convenient sites for miniscrew insertion were in the spaces comprised between second molars and first premolars; in the maxilla, between first molars and second premolars as well as between canines and lateral incisors and between the two central incisors. The interradicular spaces between the maxillary canines and lateral incisors, and between mandibular first and second premolars revealed to be influenced by the presence of dental crowding. Conclusions: The average interradicular sites map hereby proposed can be used as a general guide for miniscrew insertion at the very beginning of orthodontic treatment planning. Then, the clinician should consider the amount of crowding: if this is large, the actual interradicular space in some areas might be significantly different from what reported on average. Individualized radiographs for every patient are still recommended.

RESUMO Objetivo: elaborar um mapa dos espaços inter-radiculares nos quais os mini-implantes podem ser inseridos, em um nível coberto por gengiva inserida; e avaliar se existe correlação entre o apinhamento dentário e a disponibilidade de espaços. Métodos: radiografias panorâmicas e modelos digitais de 40 pacientes foram selecionados seguindo critérios de inclusão. Os espaços inter-radiculares foram medidos nas radiografias panorâmicas, enquanto a discrepância de modelo foi avaliada nos modelos digitais. Realizou-se, então, uma análise estatística para avaliar se os espaços inter-radiculares foram influenciados pela presença do apinhamento dentário. Resultados: na mandíbula, os locais mais adequados para a inserção dos mini-implantes foram os espaços compreendidos entre os segundos molares e primeiros pré-molares; na maxila, entre os primeiros molares e segundos pré-molares, bem como entre caninos e incisivos laterais, e entre os dois incisivos centrais. Os espaços inter-radiculares entre os caninos e incisivos laterais superiores e entre o primeiro e o segundo pré-molares inferiores mostraram-se influenciados pela presença do apinhamento dentário. Conclusões: o mapa dos espaços inter-radiculares mais adequados aqui proposto pode ser adotado como um guia geral para a inserção de mini-implantes, e pode ser usado logo ao início do planejamento do tratamento ortodôntico. Em seguida, o clínico deve levar em consideração a quantidade de apinhamento: caso esse seja grande, o real espaço inter-radicular, em algumas áreas, poderá ser significativamente diferente da média aqui relatada. Assim, recomenda-se que sempre sejam feitas radiografias individualizadas para cada paciente.

Orthodontic management of bilateral maxillary canine-first premolar transposition and bilateral agenesis of maxillary lateral incisors: a case report.

INTRODUCTION: Maxillary canine-first premolar transposition (Mx.C.P1) is an uncommon dental positional anomaly that may create many orthodontic problems from both esthetic and functional points of view. OBJECTIVE: In this report we show the orthodontic management of a case of Mx.C.P1 associated with bilateral maxillary lateral incisor agenesis and unilateral mandibular second premolar agenesis METHODS: The patient was treated with a multibracket appliance and the extraction of the lower premolar. RESULTS: treatment was completed without the need for any prosthetic replacement.

Orthodontic management of bilateral maxillary canine-first premolar transposition and bilateral agenesis of maxillary lateral incisors: a case report

INTRODUCTION: Maxillary canine-first premolar transposition (Mx.C.P1) is an uncommon dental positional anomaly that may create many orthodontic problems from both esthetic and functional points of view. OBJECTIVE: In this report we show the orthodontic management of a case of Mx.C.P1 associated with bilateral maxillary lateral incisor agenesis and unilateral mandibular second premolar agenesis METHODS: The patient was treated with a multibracket appliance and the extraction of the lower premolar. RESULTS: treatment was completed without the need for any prosthetic replacement. .

INTRODUÇÃO: a transposição entre canino e primeiro pré-molar superiores (Mx.C.P1) é uma anomalia de posição dentária rara, que pode causar muitos problemas ortodônticos, não só com relação à estética, mas também com relação à função do paciente. OBJETIVO: no presente artigo, relatamos o manejo ortodôntico de um caso de Mx.C.P1 associada à agenesia bilateral de incisivos laterais superiores e agenesia unilateral do segundo pré-molar inferior. MÉTODOS: o paciente foi tratado com aparelho ortodôntico fixo e extração do pré-molar inferior. RESULTADOS: o tratamento foi concluído sem a necessidade de reposição protética. .