Relationship between bite force, occlusal contact area, and three-dimensional facial soft tissue in dentofacial deformities.

PURPOSE: This study aimed to investigate three-dimensional facial soft tissue dimensions, maximum bite force (MBF), and occlusal contact area in patients with DFD. In addition, we analyzed the relationship between MBF and the three-dimensional facial measurements. METHODS: Thirty-two patients with skeletal Class III DFD and 20 patients with Class II DFD underwent a soft tissue evaluation using surface laser scanning, as well as MBF and occlusal contact area assessments. The DFD groups were compared with each other and with 25 healthy subjects. RESULTS: Significant morphological differences were found in the transversal, vertical, and anteroposterior dimensions between Class II DFD and Class III DFD. Both DFD groups presented an increased linear distance of chin height, which was strongly related with decreased MBF magnitude. The DFD groups exhibited lower MBF and occlusal contact area, with no significant differences between Class II and Class III DFD. CONCLUSION: The presence of DFD affected 3D measurements of facial soft tissue, causing variations beyond normal limits, lower MBF, and occlusal contact area in both Class II and Class III DFD patients. The vertical dimension might have influenced the lower MBF magnitude in the studied skeletal deformities.

Correção da má oclusão de classe II com propulsor mandibular: revisão de literatura / Correction of class II malocclusion with mandibular trusters: literature review

Introdução: a má oclusão de classe II consiste no desequilíbrio da relação entre as arcadas, podendo ser causada por deficiência mandibular, protrusão maxilar, ou ambas, sendo caracterizada pelo molar inferior distalmente posicionado em relação ao molar superior. Objetivo: este estudo tem o objetivo de apresentar uma revisão de literatura sobre a eficiência dos propulsores mandibulares fixos disponíveis no mercado odontológico no tratamento da má oclusão de classe II. Métodos: a pesquisa foi realizada nas bases de dados Google Acadêmico, SciELO e PubMed, para filtragem dos artigos selecionados. Para revisão de literatura, foram utilizados 17 artigos. Entre os protocolos de tratamento de classe II, esses aparelhos se destacam por serem fixos, por esse motivo, não dependem da colaboração direta do paciente. Com o passar dos anos, os propulsores mandibulares fixos foram cada vez mais aprimorados, oferecendo mais simplicidade na sua instalação e maior conforto ao paciente. Considerações finais: concluiu-se que os aparelhos funcionais propulsores mandibulares fixos são uma ótima escolha para o tratamento compensatório na má oclusão de classe II, sendo eficazes na correção da relação dentária e dependendo de menor cooperação do paciente.(AU)

Introduction: class II malocclusion consists of an imbalance in the relationship between the arches, which can be caused by mandibular deficiency, maxillary protrusion, or both, and is characterized by the mandibular molar distally positioned in relation to the maxillary molar. Objective: this study aims to present a literature review on the efficiency of fixed mandibular thrusters available in the dental market in the treatment of Class II malocclusion. Methods: the research was carried out in the Google Scholar, SciELO and PubMed databases to filter the selected articles. For literature review, 17 articles were used. Among Class II treatment protocols, these devices stand out for being fixed, for this reason, they do not depend on the direct collaboration of the patient. Over the years, fixed mandibular thrusters have been increasingly improved, offering more simplicity in their installation and greater comfort to the patient. Final considerations: it was concluded that the fixed mandibular thrusters functional devices are a great choice for compensatory treatment in Class II malocclusion, being effective in correcting the dental relationship and depending on less patient cooperation.(AU)

Class II malocclusion treatment changes with the Jones jig, Distal jet and First Class appliances.

Objective Maxillary molar distalization with intraoral distalizer appliances is a non-extraction orthodontic treatment used to correct molar relationship in patients with Class II malocclusion presenting maxillary dentoalveolar protrusion and minor skeletal discrepancies. This study compares the changes caused by three distalizers with different force systems. Methodology 71 patients, divided into three groups, were included. The Jones jig group (JJG, n=30; 16 male, 14 female, 13.17 years mean age) was treated with the Jones jig for 0.8 years. The Distal jet group (DJG, n=25; 8 male, 17 female, 12.57 years mean age) was treated with the Distal jet for 1.06 years. The First Class group (FCG, n=16; 6 male, 10 female, 12.84 years mean age) was treated with the First Class for 0.69 years. Intergroup treatment changes were compared using one-way ANOVA, followed by post-hoc Tukey's tests. Results Intergroup comparisons showed significantly greater maxillary incisor protrusion in DJG than in FCG (2.56±2.24 mm vs. 0.74±1.39mm, p=0.015). The maxillary first premolars showed progressive and significantly smaller mesial angulation in JJG, FCG and DJG, respectively (14.65±6.31º, 8.43±3.99º, 0.97±3.16º; p<0.001). They also showed greater mesialization in JJG than FCG (3.76±1.46 mm vs. 2.27±1.47 mm, p=0.010), and greater extrusion in DJG compared to JJG (0.90±0.77 mm vs 0.11±0.60 mm, p=0.004). The maxillary second premolars showed progressive and significantly smaller mesial angulation and mesialization in JJG, FCG and DJG, respectively (12.77±5.78º, 3.20±3.94º, -2.12±3.71º and 3.87±1.34 mm, 2.25±1.40 mm, 1.24±1.26 mm, respectively; p<0.001). DJG showed smaller distal angulation of maxillary first molars (-2.14±5.09º vs. -7.73±4.28º and -6.05±3.76º, for the JJG and FCG, respectively; p<0.001) and greater maxillary second molars extrusion (1.17±1.41 mm vs -0.02±1.16 mm and 0.16±1.40 mm, for the JJG and FCG, respectively; p=0.003). Overjet change was significantly larger in DJG compared to FCG (1.79±1.67 mm vs 0.68±0.84; p=0.046). Treatment time was smaller in FCG (0.69±0.22 years vs 0.81±0.33 years and 1.06±0.42 years, comparing it with the JJG and DJG, respectively; p=0.005). Conclusion The three appliances corrected the Class II molar relationship by dentoalveolar changes. The Distal jet produced smaller molar distal angulation than the Jones jig and First Class. The First Class appliance showed less anchorage loss, greater percentage of distalization and shorter treatment time than the Jones jig and Distal jet.

Dentoskeletal and soft-tissue changes comparison between the Jasper Jumper and Twin Force Bite Corrector in Class II malocclusion patients: A retrospective study.

OBJECTIVE: This retrospective study aimed to compare the dentoskeletal and soft-tissue changes in Class II malocclusion patients treated with Jasper Jumper and Twin Force Bite Corrector associated with fixed orthodontic appliances. MATERIAL AND METHODS: The sample comprised 60 subjects divided into 3 groups. Patients with Class II malocclusion, mandibular retrusion, slight or no crowding and with no previous orthodontic treatment were eligible. Group 1 comprised 20 patients treated with the Jasper Jumper (JJ), with an initial age of 12.39 years. Group 2 comprised 20 patients treated with the Twin Force (TF), with an initial age of 11.83 years. The control group consisted of 20 untreated Class II subjects with an initial age of 12.13 years. Intergroup pretreatment comparisons were performed with One-way analysis of variance and intergroup treatment changes were compared with the Analysis of Covariance, both followed by Tukey test. RESULTS: The TF group showed greater increase in mandibular length (6.23mm±4.64, P=0.004) than the control group (2.94mm±1.75). The mandibular incisors in the experimental groups presented significantly greater labial inclination and protrusion than the control (Md1.NB; JJ: 4.19°±2.09; TF: 4.46°±6.83; control: 1.13°±2.08, P=0.000/Md1-NB; JJ: 1.95mm±1.45; TF: 1.74mm±1.79; control: 0.31mm±0.81, P=0.000). In addition, the treated groups also showed significantly improvement of the dental relationships (Overjet; JJ: -4.05mm±4.64; TF: -3.80mm±2.12; control: 0.05mm±1.12, P=0.000/Overbite; JJ: -2.52mm±1.46; TF: -2.93mm±2.13; control: -0.63mm±1.35, P=0.000). CONCLUSION: The Jasper Jumper and Twin Force associated to fixed appliances were effective in correcting Class II malocclusion with a combination of skeletal and dentoalveolar changes. However, the TF seems to provide more skeletal effects with greater maxillary growth restriction and mandibular length increase when compared to the JJ.

Class II malocclusion treatment changes with the Jones jig, Distal jet and First Class appliances

Abstract Objective Maxillary molar distalization with intraoral distalizer appliances is a non-extraction orthodontic treatment used to correct molar relationship in patients with Class II malocclusion presenting maxillary dentoalveolar protrusion and minor skeletal discrepancies. This study compares the changes caused by three distalizers with different force systems. Methodology 71 patients, divided into three groups, were included. The Jones jig group (JJG, n=30; 16 male, 14 female, 13.17 years mean age) was treated with the Jones jig for 0.8 years. The Distal jet group (DJG, n=25; 8 male, 17 female, 12.57 years mean age) was treated with the Distal jet for 1.06 years. The First Class group (FCG, n=16; 6 male, 10 female, 12.84 years mean age) was treated with the First Class for 0.69 years. Intergroup treatment changes were compared using one-way ANOVA, followed by post-hoc Tukey's tests. Results Intergroup comparisons showed significantly greater maxillary incisor protrusion in DJG than in FCG (2.56±2.24 mm vs. 0.74±1.39mm, p=0.015). The maxillary first premolars showed progressive and significantly smaller mesial angulation in JJG, FCG and DJG, respectively (14.65±6.31º, 8.43±3.99º, 0.97±3.16º; p<0.001). They also showed greater mesialization in JJG than FCG (3.76±1.46 mm vs. 2.27±1.47 mm, p=0.010), and greater extrusion in DJG compared to JJG (0.90±0.77 mm vs 0.11±0.60 mm, p=0.004). The maxillary second premolars showed progressive and significantly smaller mesial angulation and mesialization in JJG, FCG and DJG, respectively (12.77±5.78º, 3.20±3.94º, -2.12±3.71º and 3.87±1.34 mm, 2.25±1.40 mm, 1.24±1.26 mm, respectively; p<0.001). DJG showed smaller distal angulation of maxillary first molars (-2.14±5.09º vs. -7.73±4.28º and -6.05±3.76º, for the JJG and FCG, respectively; p<0.001) and greater maxillary second molars extrusion (1.17±1.41 mm vs -0.02±1.16 mm and 0.16±1.40 mm, for the JJG and FCG, respectively; p=0.003). Overjet change was significantly larger in DJG compared to FCG (1.79±1.67 mm vs 0.68±0.84; p=0.046). Treatment time was smaller in FCG (0.69±0.22 years vs 0.81±0.33 years and 1.06±0.42 years, comparing it with the JJG and DJG, respectively; p=0.005). Conclusion The three appliances corrected the Class II molar relationship by dentoalveolar changes. The Distal jet produced smaller molar distal angulation than the Jones jig and First Class. The First Class appliance showed less anchorage loss, greater percentage of distalization and shorter treatment time than the Jones jig and Distal jet.

Long-term stability of Class II division 1 treatment with the MARA combined with fixed appliances / Avaliação da estabilidade em longo prazo da correção da Classe II divisão 1 com aparelho MARA associado ao aparelho ortodôntico fixo

Introduction: Successful treatment of class II Division 1 malocclusion is also implied to the long-term stability of treatment changes and many are the factors that can influence that. Objective: This research aimed to evaluate the long-term stability of the cephalometric changes obtained during Class II malocclusion correction with the MARA (Mandibular Anterior Repositioning Appliance) associated with fixed appliances. Methods: The treatment group comprised 12 patients who were evaluated at three stages: pretreatment (T1), posttreatment (T2) and long-term posttreatment (T3). The mean initial age of the patients was 12.35 years and the mean final age was 15.65 years. The mean age at the long-term posttreatment stage was 22.53 years and the mean long-term posttreatment period was 6.88 years. The control group comprised 12 subjects with normal occlusion and no orthodontic treatment with ages comparable to the treatment group at the posttreatment and long-term posttreatment stages. Intra-treatment group comparison between the three stages was performed with repeated measures analysis of variance (ANOVA), followed by Tukey tests. Intergroup comparison of posttreatment changes and normal growth changes of the treatment group were performed with t tests. Results: reduction of the maxillary protrusion and improvement of the maxillomandibular relationships remained stable during the long-term posttreatment period. Maxillary incisors inclination and overjet presented a tendency to relapse in relation to the control group Conclusions: Despite the different amount of growth potential, the reduction of the maxillary protrusion and maxillomandibular relationship improvement remained stable with no difference from normal occlusion behavior. Palatal inclination of the maxillary incisors and the overjet improvement showed a slight tendency towards relapse when compared to normal occlusion. Therefore, an increase of active retention time could be recommended to prevent that.(AU)

Introdução: o tratamento bem-sucedido da má oclusão de classe II Divisão 1 está implícito na estabilidade em longo prazo das correções e muitos são os fatores que podem influenciar esta estabilidade. Objetivos: observando que a terapia com o aparelho MARA (Mandibular Anterior Repositioning Appliance) associado ao aparelho ortodôntico fixo mostrou-se eficaz na correção da Classe II, este trabalho estabeleceu como objetivo avaliar cefalometricamente a estabilidade em longo prazo das correções obtidas durante este tratamento. Materiais e métodos: foram analisadas as alterações durante e após o tratamento através das telerradiografias em norma lateral de 12 pacientes (09 meninos e 03 meninas) nas fases: inicial (T1), final (T2) e pós-tratamento (T3), com idade média inicial de 12,35 anos e 15,65 anos ao final do tratamento. A idade media no estágio de pós tratamento em longo prazo foi de 22,53 e o tempo de acompanhamento pós tratamento foi em media 6,88 anos. As alterações foram comparadas a um Grupo Controle com oclusão normal, não tratados ortodonticamente, com idades compatíveis ao grupo experimental nos estágios final e pós tratamento em longo prazo. Os dados obtidos foram analisados através da análise de variância (ANOVA) para medidas repetidas e o teste de comparações múltiplas de Tukey. As alterações ocorridas no período de póstratamento foram comparadas com as alterações do Grupo Controle durante o período correspondente utilizando o teste t independente. Resultados: Observou-se uma redução da protrusão maxilar, assim como, uma melhora das relações maxilomandibulares, as quais, permaneceram estáveis durante o período de póstratamento. A inclinação dos incisivos superiores e o overjet apresentaram tendência à recidiva em relação ao grupo controle. Conclusões: A redução da protrusão maxilar e melhora da relação maxilomandibular mantiveram-se estáveis, sem diferença estatisticamente significante do comportamento na oclusão normal. A retroinclinação dos incisivos superiores e a melhora do overjet mostraram uma ligeira tendência à recidiva quando comparada ao comportamento da oclusão normal. Portanto, um aumento do tempo de retenção ativo pode ser recomendado para evitar essa recidiva.(AU)

Efetividade de um programa de terapia miofuncional no tratamento da respiração oral em indivíduos com má oclusão dentária: ensaio clínico / Effectiveness of a myofunctional therapy program in the treatment of mouth breathing in subjects with malocclusion: a clinical trial

A impossibilidade de respirar pelo nariz leva o indivíduo a desenvolver uma respiração oral que pode gerar modificações na postura lingual, labial e mandibular, bem como desarmonia dos tecidos moles, com consequente mudança na morfologia craniofacial, induzindo à má oclusão. Poucos trabalhos científicos descreveram as propostas terapêuticas empregadas ou utilizaram exames objetivos para mensurar a efetividade do tratamento miofuncional orofacial em casos de respiração oral. Sendo assim, esta pesquisa teve como objetivo verificar a efetividade de um programa miofuncional orofacial voltado ao tratamento da função respiratória em adultos com má oclusão dentária, considerando parâmetros respiratórios e a qualidade de vida em saúde oral. Participaram da pesquisa 13 indivíduos adultos em tratamento ortodôntico com má oclusão classe II, os quais foram divididos aleatoriamente em grupo experimental (GE) (n=9) e grupo controle (GC) (n=4). Foram aplicados os protocolos de qualidade de vida em saúde oral (OHIP-14) e de Sintomas Respiratórios. Além disto, foi feita a avaliação miofuncional da função respiratória, presente no protocolo MBGR, a qual envolve o tipo e modo respiratórios, fluxo nasal e possibilidade de uso nasal. Também foram avaliadas as medidas de tempo máximo de fonação (TMF) de /s/, pico do fluxo inspiratório nasal (peak-flow) e análise da medida da área de embaçamento da placa metálica, relacionada ao fluxo nasal expiratório. Foi possível observar que, após o processo terapêutico, os pacientes do GE apresentaram melhora estatisticamente significante quanto aos sintomas respiratórios (p<0,001), escore do Protocolo MBGR (p<0,001), tipo respiratório (p=0,041), modo respiratório (p=0,029), tempo máximo de fonação (p=0,002) e pico do fluxo inspiratório nasal (p=0,002), modificando os padrões que se encontravam alterados no momento pré-terapia. Já o GC permaneceu com os aspectos funcionais e sintomáticos alterados, apresentando piora quanto aos sintomas respiratórios (p=0,003) e TMF (p=0,013). Além disto, no período pré-terapia os grupos eram semelhantes entre si, sendo que após o tratamento, estes ficaram distintos no que diz respeito aos sintomas respiratórios (p=0,047), escore do protocolo MBGR (p=0,000), TMF (p=0,010) e pico do fluxo inspiratório nasal (p=0,001). Conclui-se assim, que após a aplicação do programa de terapia miofuncional orofacial para o tratamento da respiração oral, em indivíduos com má oclusão dentária, houve melhora dos parâmetros respiratórios no que diz respeito ao tipo e modo respiratório, bem como no pico inspiratório, aumento do TMF e diminuição dos sintomas respiratórios.(AU)

The inability to breathe through the nose leads the individual to develop oral breathing that can initiate changes in lingual, labial and mandibular posture, as well as soft tissue disharmony, with consequent changes in craniofacial morphology, leading to malocclusion. Few scientific papers have described the therapeutic proposals or used objective tests to measure the effectiveness of orofacial myofunctional therapy in cases of oral breathing. Thus, this research aimed to verify the effectiveness of an orofacial myofunctional program focused to the treatment of respiratory function in adults with malocclusion, considering respiratory parameters and quality of life in oral health. A total of 13 adult individuals undergoing orthodontic treatment with Class II malocclusion were randomly divided into experimental group (EG) (n=9) and control group (CG) (n=4). Oral health Impact Profile (OHIP-14) and Respiratory Symptoms protocols were applied. In addition, the myofunctional evaluation of the respiratory function, present in the MBGR protocol was performed, which involves respiratory type and mode, nasal flow and possibility of nasal use. The measures of maximum phonation time (MPT) of /s/, inspiratory peak of the nasal flow and analysis of the measurement of the haze area of the metal plate, related to the expiratory nasal flow were also evaluated. It was possible to observe that, after the therapeutic process, the EG patients had a statistically significant improvement in respiratory symptoms (p<0.001), MBGR Protocol (p<0.001), respiratory type (p=0.041), respiratory mode (p=0.029), maximal phonation time (p=0.002) and inspiratory peak flow (p=0.002), modifying patterns that were altered at the pre-therapy period. On the other hand, the CG remained with the functional and symptomatic aspects altered, presenting worsening of respiratory symptoms (p=0.003) and MPT (p=0.013). In addition, in the pre-therapy period, the groups were similar to each other, and after treatment, these were different concerning respiratory symptoms (p=0.047), MBGR Protocol (p=0.000), MPT (p=0.010) and inspiratory peak of the nasal flow (p=0.001). As conclusion, after the application of the orofacial myofunctional therapy program for the treatment of oral breathing, in individuals with malocclusion, there was an improvement in respiratory parameters regarding respiratory type and mode, as well as inspiratory peak, increased MPT and decreased respiratory symptoms.(AU)

Effects of Class II elastics in the treatment of Class II malocclusion / Alterações dentoalveolares e esqueléticas consequentes ao uso de elásticos para tratamento da má-oclusão de Classe II

Introduction: The objective of this study was to compare the effects of Class II malocclusion correction with Class II elastics with those produced by Class II malocclusion correction with extraoral headgear associated with multibracket appliances. Methods: A sample of 53 patients with Class II malocclusion was divided into two groups. The elastic group (EG) consisted of 26 patients who were treated with fixed appliances associated with Class II elastics. The control group (CG), consisted of 27 patients treated with fixed appliances and extraoral headgear. The groups were matched regarding initial age, treatment time, initial severity of Class II molar relationship and sex distribution. Pre- and posttreatment lateral cephalometric radiographs were evaluated. T tests were performed to compare the initial status and the treatment changes of the groups. Results: There was occlusal plane clockwise rotation in the EG. The maxillary incisors presented greater palatal tipping and retrusion and the mandibular incisor experienced smaller extrusion in the elastic than in the control group. Conclusion: Despite these small differences in treatment effects, they cannot be considered generally clinically unfavorable in every situation. (AU)

Introdução: O objetivo deste trabalho foi comparar as alterações resultantes do tratamento da má-oclusão de Classe II com o uso de elásticos intermaxilares de Classe II com as alterações resultantes do tratamento do mesmo tipo de má-oclusão com o uso do aparelho fixo associado ao aparelho extrabucal. Métodos: Uma amostra composta de 53 pacientes com má-oclusão de Classe II foi dividida em dois grupos. O Grupo Elástico (GE) foi composto por 26 pacientes tratados com aparelho fixo associado aos elásticos de Classe II. O Grupo Controle (GC) foi composto por 27 pacientes tratados com aparelho fixo associado ao aparelho extrabucal. Os grupos foram compatibilizados de acordo com a idade inicial, o tempo de tratamento, a severidade da má-oclusão de Classe II inicial e a distribuição por sexos. Telerradiografias laterais iniciais e finais do tratamento foram avaliadas. O teste t foi utilizado para comparar a condição inicial e as alterações do tratamento dos grupos. Resultados: Ocorreu uma rotação horária do plano oclusal no GE. Os incisivos superiores apresentaram uma maior inclinação palatina e maior retrusão, e os incisivos inferiores mostraram uma menor extrusão no GE que no GC. Conclusão: Apesar das pequenas diferenças nos efeitos dos tratamentos, eles não podem ser geralmente considerados como clinicamente desfavoráveis em todas as situações. (AU)

Changes produced by the pendulum appliance with skeletal anchorage and comparison with conventional pendulum appliance / Alterações produzidas com o aparelho pêndulo com ancoragem esquelética e comparação com o aparelho pêndulo convencional

Os propósitos destas pesquisas foram primeiramente avaliar as alterações esqueléticas, dento-alveolares e tegumentares obtidas com o aparelho pêndulo com ancoragem esquelética (BAPA) em pacientes com má oclusão Classe II e, posteriormente compará-los com os efeitos produzidos com o aparelho pêndulo com ancoragem convencional (CPA). A amostra composta de 18 pacientes (14 meninas;4 meninos) com idade média de 14.01 (D.P. 1.08) com má oclusão de Classe II tratados com BAPA como dispositivo distalizador antes do aparelho fixo, no Departamento de Ortodontia da Faculdade de Odontologia da Universidade Cidade de São Paulo. Telerradiografias laterais foram tomadas no início do tratamento (T0) e no final da distalização (T1), mensuradas e posteriormente analisadas estatisticamente. Apenas o período da distalização ativa foi avaliado. O grupo controle foi composto de 18 pacientes (14 meninas;4 meninos) com idade média de 13.61 (D.P. 1.24) com a mesma má oclusão tratados com CPA como dispositivo distalizador antes do aparelho fixo, no Departamento de Ortodontia da Faculdade de Odontologia de Bauru, Universidade de São Paulo. Para avaliar os efeitos desta amostra foi utilizada a mesma metodologia acima mencionada. Posteriormente, para comparar as alterações entre os grupos, a amostra tratada com CPA foi denominada Grupo 1 (G1), e a amostra tratada com BAPA denominada Grupo 2 (G2). O tempo médio de distalização foi 5.76 e 6.16 meses, no G1 e G2 respectivamente. Ambos os grupos foram compatibilizados em relação à idade inicial, tempo de tratamento, severidade da má oclusão de Classe II e características cefalométricas iniciais. A comparação intra-grupo foi realizada com teste t dependente, e a comparação intergrupos foi realizada com o teste t. Em G2 houve aumento significante da altura facial anteroinferior, distalização molar, inclinação distal e intrusão significante dos primeiros e segundos molares superiores. Os primeiros pré-molares apresentaram distalização e extrusão significantes. A sobremordida diminuiu e a relação molar melhoraram significativamente. Comparando as alterações do tratamento entre grupos, foram significativamente maiores a distalização, inclinação distal e intrusão dos primeiros molares no G2 comparados ao G1. Os incisivos superiores inclinaram para vestibular no G1, e ligeiramente retroinclinaram para lingual no G2, além disso os primeiros pré-molares foram distalizados no G2, porém foram mesializados no G1. O Grupo 1 apresentou aumento significativamente maior da sobressaliência, e menor correção da relação molar de Classe II do que G2. A distalização dos molares superiores foi obtida com sucesso em ambos os grupos, entretanto, utilizando o BAPA observou-se várias vantagens, tais como: Distalização exclusiva dos molares superiores; movimento distal espontâneo dos pré-molares superiores; sem efeitos colaterais indesejáveis nos incisivos superiores e nos lábios; e também o estabelecimento de uma relação molar de Classe I.(AU)

The purposes of these investigations were firstly to evaluate the dentoalveolar, skeletal and soft tissue effects obtained with the bone-anchored pendulum appliance (BAPA) in patients with Class II malocclusion and secondly, to compare these effects with the conventional pendulum appliance (CPA). A sample of 18 patients (14 females; 4 males) with a mean age of 14.01 years (S.D 1.08) with Class II malocclusion treated with BAPA as distalizer device before fixed appliance in Orthodontic Department at the Dental School, University of São Paulo City. Lateral headfilms were taken at the beginning of treatment (T0) and at the end of distalization period (T1), measured and then statistically analyzed. Only the active distalization period was evaluated. The comparison group was composed by 18 patients (14 females; 4 males) with a mean age of 13.61 years (S.D 1.24) with the same malocclusion treated with CPA before fixed appliance in Orthodontic Department at Bauru Dental School, University of São Paulo. To evaluate the effects in this sample was used the same methodology abovementioned. Then, to compare changes between groups, the sample treated with CPA was named Group 1 (G1), and the sample treated with BAPA was named Group 2 (G2). The average distalization period was 5.76 and 6.16 months, respectively for G1 and G2. Both groups were compatibilized regarding initial age, treatment time, severity of Class II malocclusion and initial cephalometric characteristics. Intragroup comparisons were performed using dependent t tests and intergroup comparisons were performed using t tests. In G2 there was significant increase in the lower anterior face height, molar distalization, distal tipping and intrusion of the first and second maxillary molars. The first premolars had significant distalization and extrusion. Overbite significantly decreased and molar relationship was significantly improved. Comparing the groups, there were significantly greater maxillary first molar distalization, distal tipping and intrusion in G2 compared to G1. The maxillary incisors were labially tipped in G1 and lingually tipped in G2. The first premolars were distalized in G2 while were mesialized in G1. G1 showed a significantly greater overjet increase and smaller Class II molar relationship correction than G2. Distalization of the maxillary molars was successfully achieved in both groups, but using the BAPA several advantages were observed including exclusive maxillary molars distalization, spontaneous distal movement of the maxillary premolars, no undesirable side effects in the maxillary incisors and lips and establishment of a Class I molar relationship.(AU)

Comparison of dentoalveolar, skeletal and soft tissue changes of the treatment of Class II malocclusion with three different intraoral distalization systems: Jones jig, Distal jet and First Class / Comparação das alterações dentoalveolares, esqueléticas e de tecido mole no tratamento da má oclusão de Classe II com três diferentes sistemas de distalização intrabucal: Jones jig, Distal jet e First Class

Introduction: This study aimed to cephalometrically compare the dentolalveolar, skeletal and soft tissue changes caused by Jones jig, Distal jet and First Class appliances. Methods: The sample included 71 patients divided into three groups. G1 (n=30; 16 male, 14 female, with a mean age of 13.17 years) was treated with Jones jig for 0.8 years. G2 (n=25; 8 male, 17 female, with a mean age of 12.57 years) was treated with Distal jet for 1.06 years. G3 (n=16; 6 male, 10 female, with a mean age of 12.84 years) was treated with First Class for 0.69 years. Intergroup treatment changes comparisons were performed using one-way ANOVA followed by Tukey tests. Results: Intergroup comparisons showed significantly greater maxillary premolar mesial angulation and first molar distal angulation in G1. The maxillary first molars presented smaller distal angulation in G2. G3 presented significantly smaller first premolar mesialization compared to G1 and smaller incisor protrusion and less overjet change compared to G2. Treatment time was significantly smaller in G3. Conclusion: All appliances corrected the Class II molar relationship. The Distal jet group produced smaller distal angulation. First Class appliance seems to produce less anchorage loss and shorter treatment time.(AU)

Introdução: Este estudo comparou cefalometricamente as alterações dentárias, esqueléticas e de tecido mole provocadas pelo Jones jig, Distal jet e First Class que apresentam um sistema de força por vestibular, por palatino e por ambos os lados, respectivamente. Métodos: Foram avaliados 71 pacientes divididos em três grupos. G1 (n=30; 16 homens, 14 mulheres, idade inicial de 13.17 anos) foi tratado com o aparelho Jones jig durante 0.8 anos. G2 (n=25; 8 homens, 17 mulheres, idade média inicial de 12.57 anos) foi tratado com o aparelho Distal jet durante 1.06 anos. G3 (n=16; 6 homens, 10 mulheres, idade média inicial de 12.84 anos) foi tratado com o aparelho First Class durante 0.69 anos. Para comparar as alterações entre os grupos utilizou-se o ANOVA a um critério seguido do teste Tukey. Resultados: G1 apresentou significativamente maior angulação mesial dos pré-molares e distal do primeiro molar superior. G2 demonstrou menor angulação distal do primeiro molar superior em relação aos outros grupos. G3 apresentou menor mesialização dos primeiros pré-molares em relação a G1 e menor protrusão dos incisivos com consequente menor aumento da sobressaliência em relação a G2. O tempo de tratamento foi significativamente menor em G3. Conclusão: Todos os grupos foram eficientes na correção da relação molar. Distal jet produz menor angulação distal do primeiro molar superior. First Class parece produzir menor movimento mesial dos dentes de ancoragem e menor tempo de tratamento.(AU)

Speech Articulatory Characteristics of Individuals With Dentofacial Deformity.

PURPOSE: To analyze the speech articulatory characteristics of individuals with dentofacial deformities (DFD) and assess differences compared to individuals with dentofacial balance. METHODS: Sixty individuals participated, being 30 presenting DFD (19 with class III and 11 class II skeletal malocclusion, 18 women and 12 men, age group 18-40 years) and 30 individuals from a control group matched for gender and age. The assessment of the diadochokinesis (DDK) was evaluated using the emissions /pa/, /ta/, /ka/, /pataka/, and /i/. RESULTS: The individuals with DFD produced fewer emissions per second: at syllable "ka" and sequence "pataka" for the total of individuals; syllable "pa" and sequence "pataka" for women, individuals with class II and class III malocclusion. The parameters related to the irregularity of the cycles were higher for the group with DFD than for the control, as well as emission of the syllable "pa" for the total of individuals, group of class III malocclusion and women, during production of the syllables "ta" and "ka" for all individuals and group of class III and during emission of the vowel "ï" for women. CONCLUSIONS: Differences regarding speed and stability of oral and laryngeal DDK were found among individuals with DFD compared with the control group.

Duration of the peak of adolescent growth spurt in class i and ii malocclusion subjects using a cervical vertebrae maturation analysis.

The aim of the present work was to determine the duration of the adolescent peak growth spurt using cervical vertebral maturation analysis in class I and II malocclusion subjects. The study was conducted on a sample which consisted of 154 lateral cephalograms of children and adolescents aged 9-15 years (84 females and 70 males). The evaluation of skeletal maturation stage was performed using a visual morphological analysis of CS3 and CS4 cervical vertebrae. The sagittal skeletal relation was evaluated according to Steiner analysis. Descriptive statistics were used to summarize chronological age in each malocclusion group and for each CS3 and CS4 skeletal maturation stage. Due to a lack of normal distribution, comparisons of CS3 and CS4 age intervals on class I and II subjects were compared using the Mann-Whitney U test for independent samples. The results show that the mean duration of the adolescent peak growth spurt was 10 months between CS3 and CS4 stages in class I malocclusion subjects, whereas in class II malocclusion patients the duration was 6 months. This difference of 4 months was statistically significant (p<0.001). Finally, a clinically significant difference of 4 months in the duration of the adolescent peak growth spurt for class I and II malocclusion subjects was identified.

The inadequacy of the Y-axis of growth (SNGn) for the vertical pattern assessment in patients with sagittal discrepancies.

AIM: The aim of this cephalometric study was to evaluate the influence of the sagittal skeletal pattern on the 'Y-axis of growth' measurement in patients with different malocclusions. MATERIALS AND METHODS: Lateral head films from 59 patients (mean age 16y 7m, ranging from 11 to 25 years) were selected after a subjective analysis of 1630 cases. Sample was grouped as follows: Group 1 - class I facial pattern; group 2 - class II facial pattern; and Group 3 - class III facial pattern. Two angular measurements, SNGoGn and SNGn, were taken in order to determine skeletal vertical facial pattern. A logistic regression with errors distributed according to a binomial distribution was used to test the influence of the sagittal relationship (Class I, II, III facial patterns) on vertical diagnostic measurement congruence (SNGoGn and SNGn). RESULTS: RESULTS show that the probability of congruence between the patterns SNGn and SNGoGn was relatively high (70%) for group 1, but for groups II (46%) and III (37%) this congruence was relatively low. CONCLUSION: The use of SNGn appears to be inappropriate to determine the vertical facial skeletal pattern of patients, due to Gn point shifting throughout sagittal discrepancies. Clinical Significance: Facial pattern determined by SNGn must be considered carefully, especially when severe sagittal discrepancies are present.

Electromyographic evaluation of masticatory muscles at rest and maximal intercuspal positions of the mandible in children with sleep bruxism.

UNLABELLED: In adults, sleep bruxism (SB) may be related to reports of pain or fatigue in the muscles of mastication, resulting from multiple muscle contractions that occur during the night. In children, little is known about the consequences of this parafunction. PURPOSE: The objective was to compare the electromyographic activity (EMG) of the masseter and anterior portion of the temporalis muscles in children with and without SB; acquisitions were made at rest (RE) and in maximal intercuspal (MI) positions of the mandible. METHODS: Twenty children with signs and symptoms of SB (mean age 7.20 years ± 0.52) and 20 controls without signs or symptoms of SB (mean age 7.40 years ± 0.50) were selected. The controls were matched to the type of occlusal morphology evaluated according to Björk et al. (Acta Odontol Scand 22:27-40, 1964). Muscle activity was measured with the mandible at RE, MI and maximal clenching with cotton roll (MC), on the left and right sides. Data from the RE and MI (mV) were normalized by calculating them as % MC. The results were analyzed by descriptive statistics, Shapiro-Wilk test, Wilcoxon and Mann-Whitney tests. RESULTS: The subjects' age did not differ significantly between groups. EMG of temporalis muscle at RE differed between the right and left sides in both groups. There was no significant difference in EMG of masseter and temporalis muscles between groups. CONCLUSION: Children with SB showed no significant difference in EMG of masticatory muscles at RE and in MI positions of the mandible when compared with the control group.

Long-term treatment effects of the FR-2 appliance: a prospective evalution 7 years post-treatment.

AIM: To examine the long-term effects induced by treatment with the function regulator (FR-2) appliance 7 years post-treatment compared with untreated class II subjects. SUBJECTS AND METHODS: The FR-2 sample was collected prospectively and comprised 17 subjects (10 boys and 7 girls, mean age 10.8 years) who were treated with the FR-2 appliance for 1.7 years and re-evaluated 7.1 years after treatment. The step-by-step mandibular advancement was performed gradually (increments up to 3-4 mm), until a 'super class I' molar relationship was obtained. The control group consisted of 17 class II subjects (9 boys and 8 girls, mean age 11.3 years) with class II malocclusion, excessive overjet, and class II molar relationship, matched to the treated group as to ages at all times, gender distribution, and stages of skeletal maturity (evaluated by the cervical vertebral maturation method). The lateral cephalograms were analysed at T1 (initial), T2 (final), and T3 (7.1 years post-treatment). The compatibility between the groups and the comparisons of their changes at T1-T2, T2-T3, and T1-T3 intervals were examined by independent sample t-tests (P < 0.05). RESULTS: FR-2 treatment provided a significant improvement in the maxillomandibular relationship due to an increase in mandibular length compared with controls, which remained stable over time. Also overjet, overbite, and molar relationship corrections demonstrated stability. Among dentoalveolar changes, only the increased mesial movement of the mandibular molars in the FR-2 group demonstrated stability. CONCLUSIONS: Correction of class II malocclusion remained stable 7 years after FR-2 treatment mainly due to the stability of the skeletal changes.

Mandibular growth and dentoalveolar development in the treatment of class II, division 1, malocclusion using Balters Bionator according to the skeletal maturation.

OBJECTIVE: The purpose of the study was to evaluate the influence of the skeletal maturation in the mandibular and dentoalveolar growth and development during the Class II, division 1, malocclusion correction with Balters bionator. METHODS: Three groups of children with Class II, division 1, malocclusion were evaluated. Two of them were treated for one year with the bionator of Balters appliance in different skeletal ages (Group 1: 6 children, 7 to 8 years old and Group 2: 10 children, 9 to 10 years old) and the other one was followed without treatment ( CONTROL GROUP: 7 children, 8 to 9 years old). Lateral 45 degree cephalometric radiographs were used for the evaluation of the mandibular growth and dentoalveolar development. Tantalum metallic implants were used as fixed and stable references for radiograph superimposition and data acquisition. Student's t test was used in the statistical analysis of the displacement of the points in the condyle, ramus, mandibular base and dental points. One-fixed criteria analysis of variance was used to evaluate group differences (95% of level of significance). RESULTS: The intragroup evaluation showed that all groups present significant skeletal growth for all points analyzed (1.2 to 3.7 mm), but in an intergroup comparison, the increments of the mandibular growth in the condyle, ramus and mandibular base were not statically different. For the dentoalveolar modifications, the less mature children showed greater labial inclination of the lower incisors (1.86 mm) and the most mature children showed greater first permanent molar extrusion (4.8 mm).

Sagittal and vertical aspects of Class II division 1 subjects according to the respiratory pattern.

INTRODUCTION: The teeth position, specially maxillary and mandibular incisors, in relation to basal bone and surrounding soft tissues must be considered in the elaboration of diagnosis, treatment planning and execution to obtain alignment, leveling, intercuspation, facial balance and harmony with stability of results. OBJECTIVE: To evaluate the modifications in the positioning of incisors in individuals with Angle Class II, division 1 malocclusion in two distinct moments of dentocraniofacial development, with mean interval of 2 years and 5 months. METHODS: The measures were obtained by means of lateral cephalograms of 40 individuals, being 23 nasal breathers (NB) and 17 mouth breathers (MB). The analyzed measures were overjet, overbite, UCI-NA, LCI-NB, UCI.NA, LCI.NB, UCI.SN, LCI.GoGn, UCI.LCI, ANB, GoGn.SN, and OccPl.SN. Statistical analysis (2-way repeated-measures ANOVA) was applied to verify intergroups differences. RESULTS: Overjet, UCI-NA, LCI-NB, ANB, GoGn.SN, and OccPl.SN demonstrated statistically significant difference (p < 0.05) when observed the moment or the respiratory method. CONCLUSIONS: There is alteration in the positioning of incisors during growth with interference of the respiratory pattern.

Mandibular growth and dentoalveolar development in the treatment of Class II, division 1, malocclusion using Balters Bionator according to the skeletal maturation

OBJECTIVE: The purpose of the study was to evaluate the influence of the skeletal maturation in the mandibular and dentoalveolar growth and development during the Class II, division 1, malocclusion correction with Balters bionator. METHODS: Three groups of children with Class II, division 1, malocclusion were evaluated. Two of them were treated for one year with the bionator of Balters appliance in different skeletal ages (Group 1: 6 children, 7 to 8 years old and Group 2: 10 children, 9 to 10 years old) and the other one was followed without treatment (Control Group: 7 children, 8 to 9 years old). Lateral 45 degree cephalometric radiographs were used for the evaluation of the mandibular growth and dentoalveolar development. Tantalum metallic implants were used as fixed and stable references for radiograph superimposition and data acquisition. Student's t test was used in the statistical analysis of the displacement of the points in the condyle, ramus, mandibular base and dental points. Analysis of variance one-fixed criteria was used to evaluate group differences (95% of level of significance). RESULTS: The intragroup evaluation showed that all groups present significant skeletal growth for all points analyzed (1.2 to 3.7 mm), but in an intergroup comparison, the increment of the mandibular growth in the condyle, ramus and mandibular base were not statically different. For the dentoalveolar modifications, the less mature children showed greater labial inclination of the lower incisors (1.86 mm) and the most mature children showed greater first permanent molar extrusion (4.8 mm).

OBJETIVO: avaliar a influência da maturação óssea no processo de crescimento e de desenvolvimento mandibular e dentoalveolar durante a correção da Classe II, divisão 1, com o Bionator de Balters. MÉTODOS: foram avaliados três grupos de crianças com Classe II, divisão 1. Dois grupos foram tratados por um ano com o aparelho Bionator de Balters, em diferentes idades esqueléticas (Grupo 1: 6 crianças, com 7 a 8 anos de idade; e Grupo 2: 10 crianças, com 9 a 10 anos); e um grupo sem tratamento (Grupo controle: 7 crianças, com 8 a 9 anos). Telerradiografias laterais em norma de 45º foram utilizadas para a avaliação do crescimento mandibular e para o desenvolvimento dentoalveolar. Implantes metálicos de tântalo foram usados como referência fixa e estável para sobreposições radiográficas e aquisição de dados. Na análise estatística do deslocamento de pontos localizados na região de côndilo, corpo e base mandibular e de pontos dentários, foi empregado o teste t de Student; para avaliar as diferenças entre os grupos, usou-se a análise de variância a um critério de classificação (nível de significância de 95%). RESULTADOS: os grupos, quando avaliados individualmente, apresentaram crescimento de todos os pontos esqueléticos de forma significativa (1,2 a 3,7mm); porém, quando comparados entre si, a quantidade de crescimento na região do côndilo, ramo e base da mandíbula não foi estatisticamente diferente. Quanto às alterações dentárias, ocorreu maior inclinação dos incisivos inferiores para vestibular (1,86mm) nos pacientes menos maduros, e maior extrusão dos primeiros molares permanentes (4,8mm) nos pacientes mais maduros.

Sagittal and vertical aspects of Class II division 1 subjects according to the respiratory pattern

INTRODUCTION: The teeth position, specially maxillary and mandibular incisors, in relation to basal bone and surrounding soft tissues must be considered in the elaboration of diagnosis, treatment planning and execution to obtain alignment, leveling, intercuspation, facial balance and harmony with stability of results. OBJECTIVES: To evaluate the modifications in the positioning of incisors in individuals with Angle Class II, division 1 malocclusion in two distinct moments of dentocraniofacial development, with mean interval of 2 years and 5 months. METHODS: The measures were obtained by means of lateral cephalograms of 40 individuals, being 23 nasal breathers (NB) and 17 mouth breathers (MB). The analyzed measures were overjet, overbite, UCI-NA, LCI-NB, UCI.NA, LCI.NB, UCI.SN, LCI.GoGn, UCI.LCI, ANB, GoGn.SN, and OccPl.SN. Statistical analysis (2-way repeated-measures ANOVA) was applied to verify intergroups differences. RESULTS: Overjet, UCI-NA, LCI-NB, ANB, GoGn.SN, and OccPl.SN demonstrated statistically significant difference (p < 0.05) when observed the moment or the respiratory method. CONCLUSION: There is alteration in the positioning of incisors during growth with interference of the respiratory pattern.

INTRODUÇÃO: a posição dos dentes, principalmente incisivos superiores e inferiores, em relação às bases ósseas e tecidos moles circundantes deve ser considerada na elaboração do diagnóstico, planejamento e execução do tratamento, para se obter alinhamento, nivelamento, intercuspidação, equilíbrio e harmonia facial com estabilidade dos resultados. OBJETIVOS: avaliar as modificações no posicionamento dos incisivos em indivíduos com má oclusão de Classe II, divisão 1, de Angle, em dois momentos distintos do desenvolvimento dentocraniofacial, num intervalo médio de 2 anos e 5 meses. MÉTODOS: as medidas foram obtidas por meio de telerradiografias em norma lateral de 40 indivíduos, sendo 23 respiradores predominantes nasais (RN) e 17 predominantemente bucais (RB). As medidas avaliadas foram sobressaliência, sobremordida, ICS-NA, ICI-NB, ICS.NA, ICI.NB, ICS.SN, ICI.GoGn, ICS.ICI, ANB, GoGn.SN, Plo.SN. Para verificar a diferença intergrupos, utilizou-se a ANOVA a dois critérios com medidas repetidas. RESULTADOS: sobressaliência, ICS-NA, ICI-NB, ANB, GoGn.SN, Plo.SN apresentaram diferença estatisticamente significativa (p < 0,05) quando observado o momento ou o modo respiratório. CONCLUSÃO: existe alteração no posicionamento dos incisivos no decorrer do crescimento, com interferência do modo respiratório.

Effect of dentofacial deformity on maximum isometric tongue strength.

The objective of this study was to determine whether dentofacial deformities (class II and class III) influence maximum isometric tongue strength compared with a group without deformities. A total of 126 adult patients participated in the study. Of these, 45 had a class II diagnosis (14 men and 31 women) and 81 a class III diagnosis (35 men and 46 women), all of them with indication of orthognathic surgery. Fifty adult volunteers (17 men and 33 women) with no changes in dental occlusion (class I) and with no clinical signs of dysfunction of the temporomandibular joint represented the control group. Tongue strength (in N) was measured with a dynamometer. The maximum strength of the anterior portion was determined with the instrument positioned on the retroincisor region and the maximum strength of the dorsum with the instrument positioned in the region of the hard palate. Data were analysed statistically by analysis of variance (anova) and by the Pearson correlation test. No significant difference (P > 0·05) in tongue strength in the anterior or dorsal region was observed between the groups with dentofacial deformities or between these groups and the control. The tongue strength of the anterior and dorsal regions was not influenced by the dentofacial deformity.