Excessive tooth wear on human dental enamel: a case report / Desgaste excessivo em esmalte dentário humano: relato de caso

Introduction: although reports on dental erosion have appeared in literature for a long time, there is currently a growing interest among researchers and clinicians about this matter. Potential risk factors for loss of dental hard tissue are changed lifestyle and eating patterns, with increased consumption of acid foods and beverages. Case report: an atypical tooth wear on the buccal surfaces of the mandibular teeth in a 45-year-old woman referred for orthodontic treatment, associated with the frequent consumption of whiskey and lemon, is reported. A comprehensive approach, such as the recognition of dental erosion joined with a careful investigation about eating habits was performed. Ultrastructural examination of replicas of the teeth showed practically structureless enamel and dentin surfaces. Conclusion: the screening for dental erosion in patients seeking orthodontic treatment is advisable to be a usual procedure. Recommendations for treatment and prophylactic measures are made emphasizing the need of multiprofessional attention.

Introdução: embora relatos sobre erosão dentária já apareçam há bastante tempo na literatura, existe atualmente interesse crescente entre pesquisadores e clínicos sobre esse assunto. Fatores que representam riscos potenciais para a perda de tecido duro do dente são as mudanças no estilo de vida e no padrão de alimentação, com o aumento no consumo de alimentos e bebidas ácidas. Relato de caso: lesões atípicas de desgaste dentário na superfície vestibular das unidades inferiores, em uma mulher com 45 de idade, encaminhada para tratamento ortodôntico, associadas ao consumo frequente de uísque e limão, foram relatadas. Uma abordagem abrangente, como o reconhecimento da erosão dentária, em conjunção com a investigação cuidadosa dos hábitos alimentares, foi realizada. O exame por meio da microscopia eletrônica de varredura, realizada em réplicas dos dentes, revelou superfícies de esmalte e dentina praticamente desprovidos de elementos estruturais. Conclusão: sugere-se que uma avaliação direcionada à busca por erosão dentária em pacientes que procuram por tratamento ortodôntico seja um procedimento rotineiro. A atenção multiprofissional, envolvendo o tratamento e o uso de medidas preventivas, é essencial para a adequada atuação junto ao paciente.

Accuracy of computer-aided image analysis in the diagnosis of odontogenic cysts: A systematic review / Precisión del análisis de imágenes asistido por ordenador en el diagnóstico de quistes odontogénicos: una revisión sistemática

Background: This study aimed to search for scientific evidence concerning the accuracy of computer-assistedanalysis for diagnosing odontogenic cysts.Material and Methods: A systematic review was conducted according to the PRISMA statements and consideringeleven databases, including the grey literature. Protocol was registered in PROSPERO (CRD 42020189349). ThePECO strategy was used to define the eligibility criteria and only studies involving diagnostic accuracy were in-cluded. Their risk of bias was investigated using the Joanna Briggs Institute Critical Appraisal tool.Results: Out of 437 identified citations, five papers, published between 2006 and 2019, fulfilled the criteria andwere included in this systematic review. A total of 5,264 images from 508 lesions, classified as radicular cyst,odontogenic keratocyst, lateral periodontal cyst, glandular odontogenic cyst, or dentigerous cyst, were analyzed.All selected articles scored low risk of bias. In three studies, the best performances were achieved when the twosubtypes of odontogenic keratocysts (solitary or syndromic) were pooled together, the case-wise analysis showinga success rate of 100% for odontogenic keratocysts and radicular cysts, in one of them. In two studies, the den-tigerous cyst was associated with the majority of misclassifications, and its omission from the dataset improvedsignificantly the classification rates. Conclusions: The overall evaluation showed all studies presented high accuracy rates of computer-aided systems inclassifying odontogenic cysts in digital images of histological tissue sections. However, due to the heterogeneity ofthe studies, a meta-analysis evaluating the outcomes of interest was not performed and a pragmatic recommendationabout their use is not possible.(AU)

Indirect orthodontic bonding with drop-shaped hot glue tray: a simple and cost-effective technique

Despite being associated with more accuracy, the indirect bonding procedure is not yet the gold standard, probably because of sensitivity of the numerous variables that must be controlled. The aim of this article was to present a modified, standardized, and low-cost indirect bonding technique that allows this procedure to be performed successfully. The technique covers an initial clinical stage, to obtain the models; a laboratory stage, which involves placement of brackets on the models following the facial axis of the clinical crown and the labial projection of the marginal ridges of the posterior teeth and construction of transfer tray using hot glue; and a second clinical stage, to properly transfer the brackets to patient's teeth. Hot glue used to build the tray molds the teeth and perfectly adapts to the teeth, having enough stiffness to maintain their anatomy and the position of the brackets, but also presenting adequate flexibility to allow removal of the tray avoiding excessive stress over the brackets. In conclusion, the new simplified indirect bonding technique presented here provides a precise placement of brackets on the models, a cheaper way to transfer them to patient, and an easy removal of transfer tray, being a very simple and cost-effective method.

Influence of dental erosion on shear bond strength of ceramic brackets bonded with two different adhesive systems: an in vitro study

This study aimed to analyze the shear bond strength (SBS) of ceramic orthodontic brackets bonded with two different adhesive systems to intact and eroded teeth. Ceramic brackets were bonded to 72 bovine central incisors divided into four groups, defined by two study factors: enamel condition (control group, kept in artificial saliva; and experimental group, eroded by using immersion cycles in Coke™ for 90 seconds, every six hours for five days), and adhesive system type (Transbond™ XT or Transbond™ Plus Color Change). Polycrystalline ceramic brackets were adhesively fixed on all specimens using the same light curing protocol. SBS was tested using 0.5 mm/min and the failure mode was classified. SBS data was analyzed using two-way ANOVA followed by Tukey test. The adhesive remnant index (ARI) scores were analyzed using Kruskal-Wallis test with Dunn's post-hoc pairwise comparison (α=0.05). Percentages of ARI scores between the groups were compared by Fisher's exact test. Spearman's correlation coefficient was applied to investigate the correlation between ARI scores and SBS values. Only the adhesive system factor had significant effect on SBS (p=0.014), Transbond™ Plus Color Change showing higher values. No significance was found for enamel condition (p=0.665) or the interaction between adhesive system and enamel condition (p=0.055). ARI scores frequencies differed between groups (p<0.001). The median ARI scores were statistically different for most comparisons among the groups. However, no significant correlation was found between ARI scores and SBS. In conclusion, the type of adhesive system affected the SBS of ceramic brackets to dental enamel, but the enamel condition, intact or eroded, had no significant effect. There was no correlation between ARI scores and SBS values, although eroded enamel tended to retain more adhesive after bracket removal.

Effect of rapid maxillary expansion on nasal cavity assessed with cone-beam computed tomography.

INTRODUCTION: Rapid maxillary expansion (RME) is assumed as a well established procedure; although, some effects on facial complex are not yet fully understood. OBJECTIVE: The aim of this research was to verify, using cone-beam computed tomography, the effect on linear dimensions of the nasal cavity. METHODS: Sample consisted of twenty patients aged 7 to 16 years, with skeletal deformity that justified the use of CT scans, and who required the RME as part of the orthodontic treatment planning. Scans were taken before clinical procedures were performed (T0) and after stabilizing the expander screw (T1). Dolphin Imaging v. 11.5 3D software was used to measure six areas on nasal cavity: three at the anterior portion (upper, middle, and lower) and other three at the posterior portion (also upper, middle, and lower). Data were statistically treated using Shapiro-Wilk test to verify normality. Differences between T0 and T1 were calculated using the Spearman correlation and paired Student's t-test, with a significance level of 5%. RESULTS: All linear measurements presented a significant increase (p< 0.05) after RME, both in the anterior and posterior regions, suggesting some parallelism on the opening pattern, especially at the lower portion (p< 0.001). CONCLUSIONS: RME was able to significantly modify the internal dimensions of the nasal cavity.

Effect of rapid maxillary expansion on nasal cavity assessed with cone-beam computed tomography

ABSTRACT Introduction: Rapid maxillary expansion (RME) is assumed as a well established procedure; although, some effects on facial complex are not yet fully understood. Objective: The aim of this research was to verify, using cone-beam computed tomography, the effect on linear dimensions of the nasal cavity. Methods: Sample consisted of twenty patients aged 7 to 16 years, with skeletal deformity that justified the use of CT scans, and who required the RME as part of the orthodontic treatment planning. Scans were taken before clinical procedures were performed (T0) and after stabilizing the expander screw (T1). Dolphin Imaging v. 11.5 3D software was used to measure six areas on nasal cavity: three at the anterior portion (upper, middle, and lower) and other three at the posterior portion (also upper, middle, and lower). Data were statistically treated using Shapiro-Wilk test to verify normality. Differences between T0 and T1 were calculated using the Spearman correlation and paired Student's t-test, with a significance level of 5%. Results: All linear measurements presented a significant increase (p< 0.05) after RME, both in the anterior and posterior regions, suggesting some parallelism on the opening pattern, especially at the lower portion (p< 0.001). Conclusions: RME was able to significantly modify the internal dimensions of the nasal cavity.

RESUMO Introdução: A expansão rápida da maxila (ERM) é um procedimento bem estabelecido. Entretanto, alguns efeitos no complexo facial ainda não foram completamente compreendidos. Objetivo: O objetivo do presente estudo foi verificar o efeito da ERM nas medidas lineares da cavidade nasal, utilizando a tomografia computadorizada de feixe cônico (TCFC). Métodos: A amostra foi composta por 20 pacientes da Universidade Federal da Bahia, com idades entre 7 e 16 anos, com deformidades esqueléticas que justificavam o uso da TCFC e que necessitavam da ERM como parte do tratamento ortodôntico. As imagens tomográficas foram realizadas antes dos procedimentos clínicos (T0) e após estabilização do parafuso expansor (T1). O software Dolphin Imaging v. 11.5 3D (Dolphin, Chatsworth, CA, EUA) foi utilizado para mensurar seis áreas na cavidade nasal, três delas na região anterior (superior, média e inferior) e outras três na região posterior (também superior, média e inferior). Os dados foram trabalhados estatisticamente, utilizando o teste de Shapiro-Wilk para avaliar a normalidade. Diferenças entre T0 e T1 foram calculadas usando a Correlação de Spearman e o teste t de Student pareado, usando um nível de significância de 5%. Resultados: Todas as mensurações lineares apresentaram um aumento significativo (p< 0,05) após a ERM, tanto na região anterior quanto na posterior, sugerindo algum paralelismo no padrão de abertura, principalmente na porção inferior (p< 0,001). Conclusão: A ERM foi capaz de modificar significativamente as dimensões internas da cavidade nasal.

Association between severity of the temporomandibular disorder, neck pain, and mandibular function impairment / Associação entre severidade da disfunção temporomandibular, cervicalgia e limitação funcional da mandíbula

ABSTRACT Purpose: to investigate the possible association between the severity of the temporomandibular disorder, cervical pain, and mandibular function impairment. Methods: is a cross-sectional, descriptive study, conducted with 32 individuals with temporomandibular disorder, categorized by degree of severity, according to the Fonseca Index. Using the diagnosis criteria for temporomandibular disorder, the likely etiological factors for the disorder were established, as well as the intensity of the functional disability, resulting from cervical pain and of the mandibular impairment. The data obtained were statistically treated, adopting the significance level of 5%. Results: the mean age was 33.8 years, 90.6% being females. As for the degree of disorder, 56.3% presented severe TMD, followed by 28.1% showing a moderate one. The myogenic etiology was present in 93.7% of the patients. Cervical pain was present in 90.6% of them, of which, 59.4% presented a mild disability, and 25%, a moderate one. Considering the mandibular function, 46.9% of the patients presented a low, 40.6%, a moderate, and 12.5%, a severe impairment. There was a statistically significant association between cervical pain and mandibular function (p = 0.011). However, although there was an increase in cervical disability and in mandibular impairment as the severity of the TMD also increased, these associations were not statistically significant (p = 0.178 and p = 0.102, respectively). Conclusion: it can be stated that there is a higher prevalence of severe TMD and of myogenic origin, and that cervical pain influences, directly, the mandibular function, which is not necessarily related to the severity of the temporomandibular alteration. Likewise, such severity does not present a relationship to mandibular function impairment either.

RESUMO Objetivo: investigar possível associação entre severidade da disfunção temporomandibular, cervicalgia e limitação funcional mandibular. Métodos: estudo seccional descritivo, em 32 indivíduos com disfunção temporomandibular, categorizados de acordo com o grau de severidade segundo o Índice de Fonseca. Utilizando-se o Critérios Diagnósticos de Pesquisa em Disfunção Temporomandibular, estabeleceram-se prováveis fatores etiológicos da disfunção e a intensidade de incapacidade funcional cervical e mandibular, avaliados pelo Índice de Incapacidade Relacionada à Dor no Pescoço e Questionário de Limitação Funcional Mandibular respectivamente. Os dados obtidos foram tratados estatisticamente, adotando-se nível de significância de 5%. Resultados: a média de idade foi de 33,8 anos, sendo 90,6% pertencentes ao gênero feminino. Quanto à severidade da disfunção, 56,3% possuíam o tipo severo, sendo moderada em 28,1%. Em 93,7%, verificou-se etiologia miogênica. A cervicalgia esteve presente em 90,6% dos pacientes, dos quais 59,4% apresentaram incapacidade leve e 25% moderada. Quanto à função mandibular, houve baixa limitação em 46,9%, moderada em 40,6%, tendo sido severa em 12,5%. Houve associação estatisticamente significante entre a cervicalgia e a função mandibular (p=0,011). Contudo, embora tenha havido aumento na incapacidade cervical e na limitação mandibular com o aumento da severidade da disfunção temporomandibular, estas associações não foram estatisticamente significantes (p=0,178 e p=0,102, respectivamente). Conclusão: é possível afirmar que há maior prevalência de disfunção temporomandibular de intensidade severa e de origem miogênica, e que a cervicalgia influencia diretamente a função mandibular, não estando necessariamente relacionada à severidade da disfunção temporomandibular. Da mesma forma, esta última também não apresenta relação direta com a limitação da função mandibular.

Non-syndromic tooth agenesis patterns and their association with other dental anomalies: A retrospective study.

OBJECTIVE: This study aimed to investigate the prevalence and the factors associated with non-syndromic tooth agenesis, besides identifying its pattern of occurrence. STUDY DESIGN: Pre-orthodontic exams of 3400 subjects, aged 8-30 years, were selected from a radiographic center in Brazil. Panoramic and periapical radiographs were analyzed to verify the presence of tooth agenesis and other six dental anomalies. Descriptive statistics were calculated using the Tooth Agenesis Code tool and, to evaluate significant associations, a negative binomial regression model was constructed. Besides, unadjusted and adjusted prevalence ratios (PR) were calculated for the bivariate and the multivariate analysis. RESULTS: Prevalence of tooth agenesis was 3.0% (n = 68) and 41 different phenotypic patterns were observed. Teeth most often symmetrically missing were maxillary lateral incisors (13.2%) and mandibular second premolars (8.8%). Females (PR = 3.49, CI 95% = 1.96-6.19) presented more tooth agenesis. Other dental anomalies, such as palatal displacement of maxillary canine and infraocclusion of primary molar were significantly more frequent (p < 0.001) in subjects with agenesis. CONCLUSION: There was a strong relationship between tooth agenesis and gender and the association with other dental anomalies was significant, with the exception of the supernumerary teeth, which seems to be independent.

Low-level laser therapy for treatment of neurosensory disorders after orthognathic surgery: A systematic review of randomized clinical trials

Background: Low-level laser has been widely used in Dentistry and many studies have focused on its application in oral surgeries. This study was conducted with the aim of searching for scientific evidence concerning the effectiveness of laser to reduce pain or paresthesia related to orthognathic surgery. Material and Methods: An electronic search was performed in PubMed, Scopus, Science Direct, LILACS, SciELO, CENTRAL, Google Scholar, OpenGrey, and ClinicalTrials.gov, up to November 2016, with no restrictions on language or year of publication. Additionally, a hand search of the reference list of the selected studies was carried out. The PICOS strategy was used to define the eligibility criteria and only randomized clinical trials were selected. Results: Out of 1,257 identified citations, three papers fulfilled the criteria and were included in the systematic review. The risk of bias was assessed according to the Cochrane Guidelines for Clinical Trials and results were exposed based on a descriptive analysis. One study showed that laser therapy was effective to reduce postoperative pain 24 hours (P=0.007) and 72 hours (P=0.007) after surgery. Other study revealed the positive effect of laser to improve neurosensory recovery 60 days after surgery, evaluated also by the two-point discrimination (P=0.005) and sensory (P=0.008) tests. The third study reported an improvement for general sensibility of 68.75% for laser group, compared with 21.43% for placebo (P=0.0095), six months after surgery. Conclusions: Individual studies suggested a positive effect of low-level laser therapy on reduction of postoperative pain and acceleration of improvement of paresthesia related to orthognathic surgery. However, due to the insufficient number and heterogeneity of studies, a meta-analysis evaluating the outcomes of interest was not performed, and a pragmatic recommendation about the use of laser therapy is not possible. This systematic review was conducted according to the statements of PRISMA and was registered at PROSPERO under the number CRD42016043258 (AU)

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Do different vertical positions of maxillary central incisors influence smile esthetics perception?

INTRODUCTION:: The purpose of this study was to determine the perception of smile esthetics among orthodontists and layperson, with respect to different maxillary central incisors vertical positions in full-face and close-up smile analyses. METHODS:: Frontal photographs of the smiles of two adult women were used. Images were altered to create a symmetrical image with the gingival margin levels of the maxillary canines matching the central incisors and a 1.0-mm central-to-lateral incisal step. Later, the images were altered in order to create six different central incisor vertical positions in 0.5-mm increments. The images were randomly assembled in an album, which was given to 114 judges, 57 orthodontists and 57 laypersons, who were asked to evaluate the attractiveness of the images using the visual analog scale. The data collected were statistically analyzed by means of 1-way analysis of variance with the Tukey post-hoc test and the Student t test. RESULTS:: The highest rated smiles showed two notable characteristics: a) the central incisor gingival margins matched or were 0.5 mm below the line of the canine gingival margins and; b) the central-to-lateral incisal step was 1.0 to 1.5 mm. The worst smiles showed two notable characteristics: a) the central incisor gingival margins were 1.0 mm above or 1.5 mm below the canine gingival margins and; b) no step between the centrals and laterals or a 2.5-mm step. CONCLUSION:: The vertical position of the maxillary central incisors significantly affected the perception of the smile esthetics, whereas slightly extruded central incisors were more esthetically preferred than intruded.

Do different vertical positions of maxillary central incisors influence smile esthetics perception?

ABSTRACT INTRODUCTION: The purpose of this study was to determine the perception of smile esthetics among orthodontists and layperson, with respect to different maxillary central incisors vertical positions in full-face and close-up smile analyses. METHODS: Frontal photographs of the smiles of two adult women were used. Images were altered to create a symmetrical image with the gingival margin levels of the maxillary canines matching the central incisors and a 1.0-mm central-to-lateral incisal step. Later, the images were altered in order to create six different central incisor vertical positions in 0.5-mm increments. The images were randomly assembled in an album, which was given to 114 judges, 57 orthodontists and 57 laypersons, who were asked to evaluate the attractiveness of the images using the visual analog scale. The data collected were statistically analyzed by means of 1-way analysis of variance with the Tukey post-hoc test and the Student t test. RESULTS: The highest rated smiles showed two notable characteristics: a) the central incisor gingival margins matched or were 0.5 mm below the line of the canine gingival margins and; b) the central-to-lateral incisal step was 1.0 to 1.5 mm. The worst smiles showed two notable characteristics: a) the central incisor gingival margins were 1.0 mm above or 1.5 mm below the canine gingival margins and; b) no step between the centrals and laterals or a 2.5-mm step. CONCLUSION: The vertical position of the maxillary central incisors significantly affected the perception of the smile esthetics, whereas slightly extruded central incisors were more esthetically preferred than intruded.

RESUMO OBJETIVO: o objetivo do presente estudo foi avaliar a percepção da estética do sorriso, entre ortodontistas e leigos, em relação a diferentes posições verticais de incisivos centrais superiores, em análises de face completa e do sorriso aproximado. MÉTODOS: foram utilizadas fotografias frontais de sorrisos de duas mulheres adultas. As imagens foram alteradas para criar uma imagem simétrica, com o nível das margens gengivais dos caninos superiores igual ao dos incisivos centrais e um degrau incisal de 1,0 mm entre central e lateral. Posteriormente, as imagens foram alteradas para criar seis diferentes posições verticais de incisivos centrais, em incrementos de 0,5 mm. As imagens foram montadas aleatoriamente em um álbum, que foi dado a 114 avaliadores (57 ortodontistas e 57 leigos), que foram convidados a avaliar a atratividade das imagens usando uma escala analógica visual. Os dados coletados foram analisados estatisticamente por meio da análise de variância (ANOVA) de um fator com o teste post-hoc de Tukey e o teste t de Student. RESULTADOS: os sorrisos mais bem avaliados apresentaram duas características notáveis: a) as margens gengivais dos incisivos centrais corresponderam ou estavam 0,5 mm abaixo da linha das margens gengivais dos caninos; b) o degrau incisal entre central e lateral foi de 1,0 a 1,5 mm. Os piores sorrisos mostraram duas características notáveis: a) as margens gengivais dos incisivos centrais estavam 1,0 mm acima ou 1,5 mm abaixo das margens gengivais dos caninos e; b) nenhum degrau entre os centrais e laterais ou um degrau de 2,5 mm. CONCLUSÃO: a posição vertical dos incisivos centrais superiores afetou significativamente a percepção da estética do sorriso, ao passo que incisivos centrais ligeiramente extruídos foram mais preferidos esteticamente do que intruídos.

Early treatment of nonsyndromic oligodontia: a clinical case report / Tratamento precoce da oligodontia não-sindrômica: relato de caso clínico

This report aims to describe the clinical case of a 10-year-old male patient (R.C.B.C.), presenting nonsyndromic oligodontia with maternal family trait and absence of 22 permanent teeth. Clinically, the patient had prolonged retention of some primary teeth and presence of permanent maxillary left central incisor, permanent mandibular right central incisor and four first permanent molars. Radiographically, only permanent maxillary second molars and mandibular third molars were developing, whereas all other germs of permanent teeth were missing. Treatment consisted of maxillary expansion followed by moving permanent maxillary left central incisor bucco-mesially, and rehabilitation of spaces with removable denture, where the main goal was to restore function and esthetic harmony. The case has been monitored for the past six years. Nonsyndromic oligodontia is a rare condition that poses significant functional and psychosocial difficulties. Treatment usually requires a multidisciplinary approach among which pediatric dentistry and orthodontics play a major role. In view of its complexity, treatment should be initiated as early as possible to minimize future functional and aesthetic issues. Dental implants are considered as definitive treatment of cases of oligodontia, however, until the patient reached the ideal age, other treatments to ensure aesthetics and function must be performed.

O objetivo deste trabalho é descrever o caso clínico do paciente R.C.B.C., dez anos de idade, gênero masculino, portador de oligodontia não associada à síndrome, com traço familiar materno e ausência de 22 dentes permanentes. Clinicamente, o paciente apresentava retenção prolongada de alguns incisivos, todos os caninos e molares decíduos e presença do incisivo central superior esquerdo, incisivo central inferior direito e os quatro primeiros molares, todos da dentição permanentes. Radiograficamente, apenas os segundos molares superiores e os terceiros molares inferiores estavam em desenvolvimento, com ausência dos demais germes dos dentes permanentes. Terapeuticamente, foi instituída a expansão maxilar seguida de mesialização e vestibularização do incisivo central superior esquerdo e de reabilitação com prótese removível, sendo o objetivo principal restaurar a harmonia estética e a função. O caso foi acompanhado há seis anos. A oligodontia não-sindrômica é considerada rara e impõe importantes dificuldades funcionais e psicossociais aos seus portadores. Geralmente, o tratamento requer uma abordagem interdisciplinar, onde a odontopediatria e a ortodontia desempenham papel primordial. Devido à complexidade envolvida, o tratamento deve ser iniciado o mais cedo possível, para minimizar futuras questões funcionais e estéticas. Os implantes dentários são considerados como tratamento definitivo para os casos de oligodontia, entretanto, até os pacientes alcançarem a idade ideal, outros tratamentos para garantir estética e função devem ser realizados.

Evaluation of the oropharynx in class I and II skeletal patterns by CBCT.

PURPOSE: This study aimed to evaluate the dimensions of the oropharynx and its shape in the minimum cross-sectional area, in individuals with Class I and Class II skeletal patterns, using three-dimensional CBCT images. METHODS: Forty-two cone-beam computed tomography images of grown individuals were evaluated. The images were divided according to the patient's skeletal patterns. The dimensions of the oropharyngeal airway space were determined using the Dolphin Imaging software. RESULTS: The volume and the minimum cross-sectional area were greater in patients with a Class I skeletal pattern, with a median difference of 5379 mm3 and 86.8 mm2, respectively. The anteroposterior and lateral diameters in the minimum cross-sectional area were also higher in Class I individuals (2.3 and 6.0 mm, respectively), but the ratio between them was not different. CONCLUSIONS: The volume and the minimum cross-sectional area of the oropharynx, as well as the anteroposterior and lateral diameters, are lower in individuals with a class II skeletal pattern than in individuals with a class I skeletal pattern. There was no difference in the shape of the oropharynx in healthy individuals with different skeletal patterns.

Correlating skeletal and dental developmental stages using radiographic parameters.

The demand for age estimation of living and deceased children considerably increased in the last years. It was mainly justified by the growing globalization trend and the enlarged amount of violent crimes involving young victims. The present research aims to correlate skeletal and dental developmental stages using radiographic parameters. Lateral cephalometric (n = 576) and panoramic (n = 576) radiographs taken in the same moment were used to asses skeletal and dental development according to the methods of Hassel and Farman (1995) and Bacetti et al. (2002), and Demirjian et al. (1973), respectively. Likelihood-ratio test was used to verify the positive prediction in correlations between developmental stages. Spearman's correlation coefficient was calculated between skeletal and dental developmental stages, as well between estimated and chronological ages. Higher prediction in correlation for the skeletal starting stage (stage 1) with stage E in mandibular canines, and with stage D in mandibular premolars and second molars was detected. Higher staging correlations were observed considering the mandibular left second premolar (0.652, p < 0.001 for the technique of Bacetti et al.; and 0.646, p < 0.001 for the technique of Hassel and Farman). Despite the correlations between skeletal and dental developmental stages, the results must be carefully interpreted once it reached moderate values (<0.652). Further researches must test different classifications of skeletal and dental development, in order to verify the possibility of replacing one technique for another with stronger correlation.

Evaluation of upper airways after bimaxillary orthognathic surgery in patients with skeletal Class III pattern using cone-beam computed tomography.

INTRODUCTION: It has been suggested that mandibular setback surgery, combined or not with maxillary advancement as a treatment alternative for patients with mandibular prognathism, can induce changes in upper airway space (UAS). Therefore, this study aimed to assess the response of the upper airway in the oropharynx region of patients with Class III skeletal pattern that underwent bimaxillary orthognathic surgery (maxillary advancement and mandibular setback) combined with mentoplasty. MATERIAL AND METHODS: The sample comprised 26 cone-beam computed tomography (CBCT) scans of 13 patients. The examination was taken before and after surgery. UAS volume, sagittal area, length and minimal axial area with its width, depth and location, were measured with the aid of Dolphin Imaging™ software version 11.5 Premium. Data were statistically treated by applying Shapiro-Wilk test and Student's paired t-test, considering as statistically significant the results of which p-value was lower than 0.05. RESULTS: No statistically significant differences were found in any measurements evaluated. CONCLUSIONS: No significant changes were observed in the oropharynx after bimaxillary orthognathic surgery and mentoplasty.

Evaluation of upper airways after bimaxillary orthognathic surgery in patients with skeletal Class III pattern using cone-beam computed tomography

Introduction: It has been suggested that mandibular setback surgery, combined or not with maxillary advancement as a treatment alternative for patients with mandibular prognathism, can induce changes in upper airway space (UAS). Therefore, this study aimed to assess the response of the upper airway in the oropharynx region of patients with Class III skeletal pattern that underwent bimaxillary orthognathic surgery (maxillary advancement and mandibular setback) combined with mentoplasty. Material and Methods: The sample comprised 26 cone-beam computed tomography (CBCT) scans of 13 patients. The examination was taken before and after surgery. UAS volume, sagittal area, length and minimal axial area with its width, depth and location, were measured with the aid of Dolphin ImagingTMsoftware version 11.5 Premium. Data were statistically treated by applying Shapiro-Wilk test and Student's paired t-test, considering as statistically significant the results of which p-value was lower than 0.05. Results: No statistically significant differences were found in any measurements evaluated. Conclusions: No significant changes were observed in the oropharynx after bimaxillary orthognathic surgery and mentoplasty.

Introdução: tem sido sugerido que a cirurgia de recuo mandibular - que é uma das alternativas de tratamento para pacientes com prognatismo mandibular -, associada ou não ao avanço maxilar, pode promover alterações no espaço das vias aéreas superiores. Por esse motivo, o presente estudo teve como objetivo avaliar o comportamento das vias aéreas superiores, na região da orofaringe, em pacientes com padrão esquelético de classe III submetidos à cirurgia ortognática bimaxilar (avanço maxilar e recuo mandibular) e mentoplastia. Métodos: a amostra foi composta por 26 tomografias computadorizadas de feixe cônico de 13 pacientes, tomadas antes e após o procedimento cirúrgico. Usando o programa Dolphin Imaging(r) versão 11.5 Premium, foram mensurados o volume do espaço orofaringeano; sua área (em um corte sagital); a mínima secção transversal dessa região, com sua largura, profundidade e localização; além de seu comprimento. Os dados obtidos foram tratados estatisticamente, tendo-se utilizado os testes Shapiro-Wilk e T-student pareado, considerando-se significativos os resultados com p < 0,05. Resultados: não foram encontradas diferenças estatisticamente significativas em qualquer uma das medidas avaliadas. Conclusão: não foram observadas modificações significativas na orofaringe após a realização da cirurgia ortognática bimaxilar e mentoplastia.

Early treatment of patient with Class III skeletal and dental patterns.

Class III skeletal pattern is characterized by disharmony between maxillary and mandibular basal bones anteroposteriorly, and might or might not be associated with dental changes. In general, facial esthetics is hindered significantly, which most of times is the reason why patients or patient's guardians seek treatment. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) in partial fulfillment of the requirements for Diplomate recertification and revalidation.

Early treatment of patient with Class III skeletal and dental patterns

Abstract Class III skeletal pattern is characterized by disharmony between maxillary and mandibular basal bones anteroposteriorly, and might or might not be associated with dental changes. In general, facial esthetics is hindered significantly, which most of times is the reason why patients or patient's guardians seek treatment. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) in partial fulfillment of the requirements for Diplomate recertification and revalidation.

Resumo O padrão esquelético de Classe III é caracterizado pela desarmonia entre as bases ósseas maxilar e mandibular, no sentido anteroposterior, podendo ou não estar acompanhada por alterações dentárias. Em geral, o aspecto estético facial fica bastante comprometido, sendo justamente esse o fator que, na maioria das vezes, motiva o paciente ou seus responsáveis a procurar pelo tratamento. Este caso clínico foi apresentado à Diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO) como parte dos requisitos para o processo de recertificação e revalidação do título de Diplomado pelo BBO.

Reliability, efficacy and reproducibility of the cervical vertebrae maturation index (CVMI) / Validade, efetividade e reprodutibilidade do índice de maturação das vértebras cervicais

Assessing skeletal maturation is an important determinant of successful orthodontic treatment planning for children and adolescents. While several methods are used skeletal maturation assessment, the hand-wrist radiograph is one of the most widely used. However, it does require additional exposing growing patients to additional radiation. Information on skeletal maturation can also be retrieved after evaluation of cervical vertebrae, which are commonly portrayed on the lateral cephalometric radiographs included in standard orthodontic documentation. By means of a systematic review of the available literature, this work aimed to verify the reliability, efficacy, and reproducibility of skeletal age determination based on the evaluation of cervical vertebrae. The LILACS, SciELO and PubMed databases were searched using the keywords "cervical vertebrae" and "cervical maturation". Only texts in Portuguese, Spanish, and English published in the last 10 years were selected. Twenty-nine full articles were retrieved and critically appraised. According to these references, the Cervical Vertebrae Maturation Index appears to be a valid, reliable, and reproducible method for skeletal maturation assessment and may substitute the analysis of hand-wrist radiograph in orthodontic treatment planning.

A determinação da fase de maturação esquelética é ponto fundamental no tratamento ortodôntico de crianças e adolescentes, e muitos métodos são utilizados com este objetivo, sendo a análise da radiografia de mão e punho o mais comumente difundido no meio ortodôntico. Entretanto, esta informação também pode ser obtida por meio de radiografias cefalométricas laterais, com base na avaliação das vértebras cervicais, eliminando a necessidade de exposição a mais de radiação e o custo associado de novos exames. O objetivo deste trabalho foi checar, com base na literatura, a confiabilidade, a efetividade e a reprodutibilidade do método de estimativa da idade esquelética, por meio das vértebras cervicais. Para tanto, foi realizada uma revisão crítica da literatura, utilizando as palavras-chave "vértebras cervicais" e "maturação cervical". Foram encontrados 29 artigos nas bases de dados LILACS, PubMed e SciELO. De acordo com as referências encontradas, o Índice de Maturação das Vértebras Cervicais pode ser considerado um método válido, confiável e reprodutível na análise da maturação óssea, podendo ser utilizado na prática ortodôntica, em substituição à análise da radiografia de mão e punho.

A proporção entre o vermelho dos lábios superior e inferior influencia na estética facial de homens? / Influence of the ratio between upper and lower lip vermilion on the facial esthetics of white men

O objetivo deste trabalho foi comparar a percepção estética de ortodontistas, dermatologistas e leigos frente a modificações na proporção do vermelhão nos lábio superiores e inferiores de três homens adultos leucodermas. Faces de três homens leucodermas ente 20 e 30 anos de idade, foram fotografadas e maquiadas a fim de produzir, a partir dos lábio originais de cada um, cinco proporções distintas entre o vermelhão dos lábios superior e inferior: 1:1; 1:1,5; 1,5:1; 1:2 e 2:1. As imagens geradas foram avaliadas por ortodontistas, dermatologistas e leigos que indicaram, por meio de escala visual analógica, o nível de atratividade de cada imagem. Houve concordância entre os avaliadores, que consideraram mais atrativa a proporção entre o vermelhão dos lábios superior e inferior de 1:1, sem diferença estatisticamente significativa (p>0,05) entre os três homens. A proporção entre o vermelhão dos lábios superior e inferior exerceu forte estética.