Tratamentos da classe II, com e sem extrações, e sua influência na estética facial em longo prazo

Altamente prevalente, a má-oclusão de classe II pode ser tratada com extrações de pré-molares. Porém, o ortodontista teme a repercussão negativa delas na face dos pacientes. Quando podemos extrair sem este medo? Quais fatores considerar: idade, severidade, apinhamento, padrão facial, projeção nasal, ângulo nasolabial? Avaliações 15 anos após tratamento mostram a influência estética em longo prazo dos diferentes protocolos de extração em pacientes classe II

Nowadays, the seek for aesthetics has been the subject of increased demanbd for orthodontiuc treatment in adults. The tooth agenesis has a great influence on the smile esthetics and consequently the harmony of the face, which is significantly affected by the absence of lateral incisors. Among the various treatment forms, the clinician can decide for space closure with replacement of the lateral incisor or canine space opening for later prosthetic implant rehabilitation. In the maxillary lateral incisors and made a literatura review about the treatment options, focusing on space opening associated with the planning and 3-D aesthetic management through the prothetic implant rehabilitation

Influence of premolar extractions on long-term adult facial aesthetics and apparent age.

OBJECTIVES: This study aimed to assess whether non-extraction, two-premolars and four-premolars extraction Class II treatment protocols are different regarding long-term facial aesthetics, age appearance, and soft-tissue measures. METHODS: Frontal and lateral photographs of 63 full Class II division 1 patients, treated at least 8 years before, were evaluated by 83 laypeople and 76 orthodontists, who assigned to each one's attractiveness scores from 1 to 10, and opined about their apparent ages. Patients were divided in three groups: XP0 (non-extraction, n = 20; 30.77 years, 15.63 years post-treatment), XP2 (two-premolars extractions, n = 25; 30.99 years, 15.68 years post-treatment), and XP4 (four-premolar extractions, n = 18; 32.80 years, 18.01 years post-treatment), that were matched by gender, post-treatment occlusal and soft-tissue outcomes, age, and post-treatment time. Soft-tissue measures were obtained with Dolphin Imaging 11.5 software. RESULTS: Two-way analysis of variance revealed that attractiveness and apparent age were not affected by treatment protocols, but laypeople were slightly more critical then orthodontists. Analysis of variance showed more vertical facial pattern in XP4 group. Pearson correlation test revealed no influence of soft-tissue measures on sample's attractiveness. CONCLUSIONS: Treatment of full Class II division 1 malocclusion with and without extractions did not influence facial attractiveness, age appearance, and overall soft-tissue measures in the long-term.

Soft-tissue changes in Class II malocclusion patients treated with extractions: a systematic review.

BACKGROUND: Concerns about the effects caused by premolar extractions on the soft-tissue profile have motivated many investigations in different malocclusions. OBJECTIVES: To evaluate the cephalometric facial soft-tissue changes after orthodontic treatment with premolar extractions of Class II division 1 malocclusion subjects. SEARCH METHODS: Electronic databases PubMed, Web of Science, Embase, and Scopus were searched. SELECTION CRITERIA: Abstracts that appeared to fulfil the initial criteria (premolar extraction; cephalometric soft-tissue analyses/changes) were selected. The full-text original articles were then retrieved. Their references were also hand-searched. DATA COLLECTION AND ANALYSIS: By consensus of two researchers, the articles that fulfilled the selection criteria and quantified facial soft-tissue changes were individually analysed. Some methodological flaws were identified and some articles were excluded. The studies were rated according to the type of study, sample description and homogeneity, malocclusion severity, consideration of confounding factors, validity of the method, and statistical analyses. RESULTS: Heterogeneous information about malocclusion severity before treatment was found in most articles. Statistically significant soft-tissue changes reported included nasolabial angle (NLA) increasing from 2.4 to 5.40degrees in 2-premolar extraction protocol and from 1 to 6.84degrees in 4-premolar extraction protocol. Retrusion of the upper and lower lips were also verified, with less retraction of the lower lip in 2-premolar extraction groups. CONCLUSIONS: When Class II division 1 malocclusion is treated with premolar extractions, the NLA increases and the lips are retracted. However, there is less retraction of the lower lip in the 2-maxillary premolar extraction protocol.

Extractions in orthodontics: a treatment time evaluation and a profile susceptibility study / Extrações em ortodontia: uma avaliação sobre tempo de tratamento e susceptibilidade do perfil

Able to significantly help in some malocclusions treatment, premolar extractions for orthodontic reasons has been extensively researched. The present thesis evaluated different aspects related to this type of extraction. The first study aimed to evaluate treatment duration of cases treated with four first premolars extraction, with and without dental crowding. After evaluating 150 Angle Class I malocclusion cases treated likewise, 74 selected individuals were divided into groups with mild and severe crowding. Although the treatment time was higher in the mild crowding group, that difference only became statistically significant difference after the groups were reselection of with more extreme crowding amounts. To achieve that, the groups were reduced. It is suggested this research should be repeated with a greater sample. The second study, through a certain type of article ­ a systematic review of the literature ­ was based on the common concern from orthodontists that their treatment could impact patients' soft tissue profiles, especially treatments based on extractions. Lips projection and nasolabial angle values obtained from attractive samples were gathered. Results varied according to ethnicity and sex, showing that each patient must be evaluated considering the context he/she is inserted in. The orthodontic patients who show cephalometric values of lips projection and nasolabial angle similar to those reported in this study and are considered already attractive should be treated not changing the lips position.(AU)

Capaz de auxiliar significativamente o tratamento de diferentes más oclusões, as extrações de pré-molares por indicação ortodôntica têm sido alvo de vasta investigação na comunidade científica. O presente trabalho avaliou diferentes aspectos relacionados a este tipo de extrações. No primeiro estudo, o objetivo foi avaliar o tempo de tratamento em casos tratados com extração de quatro primeiros pré-molares com e sem apinhamento dentário. Após avaliar 150 casos de má oclusão de Classe I de Angle assim tratada, 74 indivíduos foram selecionados e divididos em dois grupos, com apinhamento suave e severo. Embora o tempo de tratamento tenha sido maior no grupo sem apinhamento, esta diferença só se tornou estatisticamente significante após a seleção de grupos com graus mais extremos de apinhamento. Dado que para isso os grupos se reduziram, sugere-se que esta investigação seja repetida com uma amostra maior. O segundo estudo, por meio de um tipo diferente e específico de artigo ­ uma revisão sistemática da literatura ortodôntica ­ focou na constante preocupação dos ortodontistas quanto à repercussão de seus tratamentos nos perfis dos pacientes, especialmente daqueles apoiados em extrações. Valores de projeção labial e ângulo nasolabial obtidos de perfis esteticamente julgados por avaliadores como atraentes em pesquisas científicas foram reunidos. Os resultados variaram conforme etnia e sexo, mostrando que cada paciente deve ser avaliado considerando o contexto em que se insere. Os pacientes ortodônticos que apresentarem valores cefalométricos de projeção labial e ângulo nasolabial similares aos reportados neste estudo e que já forem considerados esteticamente agradáveis devem ser tratados sem grande acometimento da posição labial.(AU)

Comparison between full face and hemifacial CBCT cephalograms in clinically symmetrical patients: a pilot study.

INTRODUCTION: One of the advantages of cone-beam computed tomography (CBCT) is the possibility of obtaining images of conventional lateral cephalograms derived from partial or complete reconstruction of facial images. OBJECTIVE: This study aimed at comparing full face, right and left hemifacial CBCT cephalograms of orthodontic patients without clinical facial asymmetry. METHODS: The sample comprised nine clinically symmetrical patients who had pretreatment full face CBCT. The CBCTs were reconstructed so as to obtain full face, right and left hemifacial cephalograms. Two observers, at two different times, obtained linear and angular measurements for the images using Dolphin 3D software. Dependent and independent t-tests were used to assess the reproducibility of measurements. Analysis of Variance and Kruskal-Wallis tests were used to compare the variables obtained in the CBCT derived cephalometric views. RESULTS: There was good reproducibility for CBCT scans and no statistically significant differences between measurements of full face, right and left hemifacial CBCT scans. CONCLUSIONS: Cephalometric measurements in full face, right and left hemifacial CBCT scans in clinically symmetrical patients are similar.

Comparison between full face and hemifacial CBCT cephalograms in clinically symmetrical patients: a pilot study

INTRODUCTION: One of the advantages of cone-beam computed tomography (CBCT) is the possibility of obtaining images of conventional lateral cephalograms derived from partial or complete reconstruction of facial images. OBJECTIVE: This study aimed at comparing full face, right and left hemifacial CBCT cephalograms of orthodontic patients without clinical facial asymmetry. METHODS: The sample comprised nine clinically symmetrical patients who had pretreament full face CBCT. The CBCTs were reconstructed so as to obtain full face, right and left hemifacial cephalograms. Two observers, at two different times, obtained linear and angular measurements for the images using Dolphin 3D software. Dependent and independent t-tests were used to assess the reproducibility of measurements. Analysis of Variance and Kruskal-Wallis tests were used to compare the variables obtained in the CBCT derived cephalometric views. RESULTS: There was good reproducibility for CBCT scans and no statistically significant differences between measurements of full face, right and left hemifacial CBCT scans. CONCLUSIONS: Cephalometric measurements in full face, right and left hemifacial CBCT scans in clinically symmetrical patients are similar. .

INTRODUÇÃO: uma das vantagens da tomografia computadorizada de feixe cônico (TCFC) é a possibilidade de obtenção da imagem da telerradiografia em norma lateral convencional, por reconstruir parcial ou totalmente a face em uma visão sagital. OBJETIVO: o presente estudo teve como objetivo comparar as imagens de cefalogramas obtidas da face total e das hemifaces direita e esquerda por meio de TCFC, em pacientes sem assimetria clinica. MÉTODOS: a amostra foi composta por nove pacientes, clinicamente simétricos, que tinham em seus prontuários TCFC de face total. Os exames tomográficos foram reformatados para a obtenção de cefalogramas de face total e hemifaces direita e esquerda. Dois observadores, em dois momentos diferentes, obtiveram medidas lineares e angulares dessas imagens, utilizando o software Dolphin 3D. Testes t dependentes e independentes foram utilizados para verificar a reprodutibilidade das medidas nas imagens. Análise de variância (ANOVA) e o teste de Kruskal-Wallis foram utilizados para comparar as variáveis obtidas nas análises cefalométricas. RESULTADOS: houve boa reprodutibilidade para as imagens de TCFC e não houve diferença estatisticamente significante entre as medidas cefalométricas obtidas de cefalogramas de face total, hemifaces direita e esquerda. CONCLUSÕES: medidas cefalométricas obtidas de cefalogramas de face total, hemifaces direita e esquerda em pacientes clinicamente simétricos são semelhantes. .

Influência de extrações de pré-molares na estética facial em longo prazo / Influence of premolar extractions on facial aesthetics in the long term

A indicação da extração de pré-molares em Ortodontia tem sido questionada por eventuais riscos à estética facial. Este estudo se propôs a avaliar se os protocolos de tratamento da Classe II divisão 1 sem extrações, com extrações de dois pré-molares superiores e de quatro pré-molares são diferentes entre si quanto à estética facial, em longo prazo. Foram avaliados 63 indivíduos Classe II divisão 1 completa, tratados ortodonticamente há pelo menos oito anos, compatíveis quanto a sexo, idade, tempo pós-tratamento, qualidade de finalização do tratamento quanto ao perfil e à oclusão (índice Objective Grading System) e sobressaliência (final e em longo prazo). O grupo XP0 foi composto por 20 indivíduos, tratados sem extrações (30,77 anos de idade; 15,63 anos pós-tratamento). O grupo XP2 foi composto de 25 indivíduos, tratados com extração de dois pré-molares superiores (30,99 anos de idade; 15,68 anos pós-tratamento). O grupo XP4 foi composto por 18 indivíduos, tratados com extração de quatro pré-molares (32,80 anos de idade; 18,01 anos póstratamento).Leigos e ortodontistas avaliaram fotografias extra-bucais frontais e laterais em repouso dos indivíduos, atribuindo notas de 1 a 10 à atratividade de cada um e opinando sobre suas idades aparentes. Medidas tegumentares foram obtidas das fotografias laterais através do programa Dolphin Imaging 11.5. Análises de Variância a dois critérios revelaram que tanto a atratividade como a idade aparente não foram influenciadas pelos protocolos de tratamento e sim pelo tipo de avaliador, tendo sido os leigos ligeiramente mais críticos em relação aos ortodontistas. A Análise de Covariância revelou que a idade dos avaliadores não interferiu sobre suas opiniões, mas o sexo sim, tendo as mulheres designado notas superiores à dos homens. A Análise de Variância revelou que o padrão facial foi suavemente mais vertical no grupo XP4. O teste de correlação de Pearson revelou que nenhuma dasmedidas tegumentares avaliadas teve influência...

The assumption that extraction treatment can impair the facial profile with excessive retrusion has discouraged this treatment protocol. This study aimed to assess whether the nonextraction, extraction of two maxillary premolars and extraction of four premolars treatment protocols of Class II Division 1 are different regarding facial esthetics in the long-term. Frontal and lateral photographs of 63 patients, treated at least eight years ago, that initially presented complete Class II division 1 malocclusion, were divided into 3 groups as following: XP0 (non-extraction, n=20; 30,77 years, 15,63 years post-treatment), XP2 (2-maxillary premolar extractions, n=25; 30,99 years, 15,68 years post-treatment) and G3 (4-premolar extractions, n=18; 32,80 years of age, 18,01 years post-treatment). All groups were matched by gender, age, posttreatment time, final profile and occlusal outcomes (Objective Grading System Index), final and long-term overjets. Laypersons and orthodontists evaluated frontal and lateral photographs of the individuals, assigning scores from 1 to 10 to each ones attractiveness and opining about their apparent ages. Cephalometric soft tissue measures were obtained from the lateral photographs by the software Dolphin Imaging 11.5. Two-way Analysis of Variance revealed that both attractiveness and apparent age were not affected by treatment protocols, but by the type of evaluator. Laymen were slightly more critical then orthodontists. Analysis of covariance revealed that the age of the raters did not affect their opinions, but the genre did, as long as women assigned higher grades than did men. Analysis of variance showed no statistically significant differences between the three groups, except for the facial pattern, which was slightly larger in XP4. The Pearson correlation test revealed that none of the soft-tissue measures evaluated had influence on the facial attractiveness scores assigned to the sample...