A comparative study of the accuracy between two computer-aided surgical simulation methods in virtual surgical planning.

OBJECTIVE: The aim of this retrospective and observational study was to compare the accuracy of two different virtual surgical planning (VSP) protocols, namely, the CASS method and the modified CASS method. MATERIALS AND METHODS: The patients underwent bimaxillary orthognathic surgery, planned using either the CASS method or the modified CASS method. Linear and angular discrepancies between the VSP outcome and postoperative outcome for both groups were compared for maxilla, mandible, and chin segments. Aside from the comparison between both groups, additional criteria were used to determine the accuracy of the protocol based on a linear and angular difference between planned and actual outcomes of less than 2 mm and 4°, respectively. The intergroup comparisons were performed by one-way ANOVA, with the level of significance set at 5%. RESULTS: A total of 21 patients, of both genders, were assigned into group I (n = 11), planned with the CASS method, and group II (n = 10), planned with the modified CASS method. Both the CASS and modified CASS methods presented similar accuracy with regard to linear differences for the maxilla, mandible, and chin segments, except for ΔX for the mandibular segment, where the modified CASS method showed slightly better accuracy. However, there was a statistically significant difference with regard to angular differences in the chin segment, with the CASS method shown to be the more accurate. Aside from Δpitch for the chin segment, no linear or angular differences exceeded 2 mm or 4°. CONCLUSION: Although statistically significant differences were found with regard to angular measurements in the chin segment, the accuracy of the modified CASS method for virtual planning can be considered as clinically equivalent, with a performance comparable to that of the CASS method.

Negligible tooth resorptions after anterior open bite treatment using skeletal anchorage with miniplates.

INTRODUCTION: When miniplates are used as anchoring for orthodontic mechanics for anterior open bite correction by retraction of anterior teeth and posterior teeth intrusion and retraction, orthodontically induced inflammatory external apical root resorption is clinically negligible. METHODS: A homogeneous sample of 32 patients was used, and the roots of the teeth were compared on CT scans performed before and after orthodontic treatment. RESULTS: The observed root resorption was minimal, and this can be explained by the uniform distribution of forces in several teeth, simultaneously, in the set of the dental arch and in the bone that supports the teeth. CONCLUSION: The most important thing to prevent root resorption in orthodontic practice, besides being concerned with the intensity of the applied forces, is to be careful with its distribution along the roots of each tooth, in the dental arch and in the bone that supports the teeth.

Negligible tooth resorptions after anterior open bite treatment using skeletal anchorage with miniplates

ABSTRACT Introduction: When miniplates are used as anchoring for orthodontic mechanics for anterior open bite correction by retraction of anterior teeth and posterior teeth intrusion and retraction, orthodontically induced inflammatory external apical root resorption is clinically negligible. Methods: A homogeneous sample of 32 patients was used, and the roots of the teeth were compared on CT scans performed before and after orthodontic treatment. Results: The observed root resorption was minimal, and this can be explained by the uniform distribution of forces in several teeth, simultaneously, in the set of the dental arch and in the bone that supports the teeth. Conclusion: The most important thing to prevent root resorption in orthodontic practice, besides being concerned with the intensity of the applied forces, is to be careful with its distribution along the roots of each tooth, in the dental arch and in the bone that supports the teeth.

RESUMO Introdução: Quando são utilizadas miniplacas como ancoragem para a mecânica ortodôntica de correção da mordida aberta anterior por meio da retração dos dentes anteriores e intrusão e retração dos dentes posteriores, as reabsorções radiculares apicais externas inflamatórias induzidas ortodonticamente são clinicamente irrelevantes. Métodos: Usou-se uma amostra homogênea de 32 pacientes, e comparou-se as raízes dos dentes em tomografias realizadas antes e depois do tratamento ortodôntico. Resultados: As reabsorções radiculares observadas foram mínimas, e isso pode ser explicado pela distribuição uniforme das forças em vários dentes, simultaneamente, no conjunto da arcada dentária e no osso que suporta os dentes. Conclusão: O mais importante para se prevenir as reabsorções radiculares na prática ortodôntica, além de se preocupar com a intensidade das forças aplicadas, é tomar cuidado com a sua distribuição ao longo das raízes de cada dente, na arcada dentária e no osso que suporta os dentes.

Prevalence of long face pattern in Brazilian individuals of different ethnic backgrounds.

OBJECTIVE: The long face pattern is a facial deformity with increased anterior total facial height due to vertical excess of the lower facial third. Individuals with long face may present different degrees of severity in vertical excess, as well as malocclusions that are difficult to manage. The categorization of vertical excess is useful to determine the treatment prognosis. This survey assessed the distribution of ethnically different individuals with vertical excess according to three levels of severity and determined the prevalence of long face pattern. MATERIAL AND METHODS: The survey was comprised of 5,020 individuals of Brazilian ethnicity (2,480 females and 2,540 males) enrolled in middle schools in Bauru-SP, Brazil. The criterion for inclusion of individuals with vertically impaired facial relationships was based on lip incompetence, evaluated under natural light, in standing natural head position with the lips at rest. Once identified, the individuals were classified into three subtypes according to the severity: mild, moderate, and severe. Then the pooled sample was distributed according to ethnical background as White (Caucasoid), Black (African descent), Brown (mixed descent), Yellow (Asian descent) and Brazilian Indian (Brazilian native descent). The Chi-square (χ²) test was used (p<0.05) to compare the frequency ratios of individuals with vertically impaired facial relationships in the total sample and among different ethnicities, according to the three levels of severity. RESULTS: The severe subtype was rare, except in Black individuals (7.32%), who also presented the highest relative frequency (45.53%) of moderate subtype, followed by Brown individuals (43.40%). In the mild subtype, Yellow (68.08%) and White individuals (62.21%) showed similar and higher relative frequency values. CONCLUSIONS: Black individuals had greater prevalence of long face pattern, followed by Brown, White and Yellow individuals. The prevalence of long face pattern was 14.06% in which 13.39% and 0.68% belonged to moderate and severe subtypes, respectively.

Diagnóstico diferencial e abordagens terapêuticas no manejo / Differential diagnosis and therapeutic approaches in the

O manejo da má-oclusão de Classe II, subdivisão, pode ser um desafio devido ao seu caráter etiológico multifatorial, onde o erro no diagnóstico implicaria em equívocos, entre eles um longo tempo de tratamento. O diagnóstico diferencial é a chave para estabelecer um planejamento ortodôntico efetivo, considerando que a classificação de Angle não permite especificidade, podendo abrigar em uma mesma nomenclatura variados desvios morfológicos dentofaciais. Esta revisão objetivou descrever as características morfológicas, bem como estabelecer parâmetros de diagnóstico diferencial para que o clínico tenha maior segurança em avaliar, prognosticar e conduzir o tratamento da má-oclusão de Classe II, subdivisão. Pouco tem sido descrito a respeito dos aspectos faciais dos pacientes portadores da má-oclusão de Classe II, subdivisão, contrastando com a quantidade de informações encontradas na literatura sobre as características dentoalveolares, radiográficas e tomográficas. Quanto à natureza, a Classe II, subdivisão, é predominantemente dentoalveolar; quanto à localização, o problema se encontra primariamente no arco inferior e, secundariamente, no arco superior. As decisões terapêuticas podem envolver extrações ou não e, em casos extremos, procedimentos ortocirúrgicos, as quais devem basear-se, para o planejamento, nas características da face, relação labial, localização, magnitude do erro e gravidade do apinhamento.

The management of Class II, subdivision malocclusion may be a challenge due to its multifactor etiology feature, where the misdiagnosis would imply in misconceptions, including a long time of treatment. The differential diagnosis is the crucial key to establish an effective orthodontic treatment planning, bearing in mind that Angle’s classification show little specificity, which may cover a range of dentofacial morphological deviations under same nomenclature. This review aimed to describe the morphological characteristics as well as to establish the parameters of differential diagnosis, so that the clinician would have more assurance in evaluating, prognosticating and conducting the treatment of the Class II, subdivision malocclusion. Scarce information related to facial features of Class II, subdivision malocclusion individuals can be found in the literature in contrast to the amount of information with regard to the dentoalveolar, radiographic and tomographic characteristics. In relation to its nature and localization, Class II, subdivision is predominantly dentoalveolar, primarily located at the lower arch and, secondly, at the upper arch. The therapeutic decisions may involve extraction or nonextraction and, in the extreme cases, ortho-surgical procedures, which should be made on the basis of the features of facial pattern, lips relationship, the localization and the magnitude of Class II and the severity of dental crowding.

Prevalence of long face pattern in Brazilian individuals of different ethnic backgrounds

Objective: The long face pattern is a facial deformity with increased anterior total facial height due to vertical excess of the lower facial third. Individuals with long face may present different degrees of severity in vertical excess, as well as malocclusions that are difficult to manage. The categorization of vertical excess is useful to determine the treatment prognosis. This survey assessed the distribution of ethnically different individuals with vertical excess according to three levels of severity and determined the prevalence of long face pattern. Material and Methods: The survey was comprised of 5,020 individuals of Brazilian ethnicity (2,480 females and 2,540 males) enrolled in middle schools in Bauru-SP, Brazil. The criterion for inclusion of individuals with vertically impaired facial relationships was based on lip incompetence, evaluated under natural light, in standing natural head position with the lips at rest. Once identified, the individuals were classified into three subtypes according to the severity: mild, moderate, and severe. Then the pooled sample was distributed according to ethnical background as White (Caucasoid), Black (African descent), Brown (mixed descent), Yellow (Asian descent) and Brazilian Indian (Brazilian native descent). The Chi-square (χ 2 ) test was used (p<0.05) to compare the frequency ratios of individuals with vertically impaired facial relationships in the total sample and among different ethnicities, according to the three levels of severity. Results: The severe subtype was rare, except in Black individuals (7.32%), who also presented the highest relative frequency (45.53%) of moderate subtype, followed by Brown individuals (43.40%). In the mild subtype, Yellow (68.08%) and White individuals (62.21%) showed similar and higher relative frequency values. Conclusions: Black individuals had greater prevalence of long face pattern, followed by Brown, White and Yellow individuals. The prevalence of long face pattern was 14.06% in which 13.39% and 0.68% belonged to moderate and severe subtypes, respectively.

Epidemiologia do Padrão Face Longa em escolares do ensino fundamental do município de Bauru-SP: considerando o dimorfismo sexual / Epidemiology of Long Face Pattern in school children attending middle schools at the city of Bauru-SP: concerns about sexual dimorphism

Objetivo: Investigar o dimorfismo sexual na prevalência dos indivíduos portadores de com-prometimento vertical nas relações faciais por excesso (conforme a severidade da discrepância) e, especialmente, dos portadores de Padrão Face Longa. Métodos: A amostra constou de 5020 sujeitos de etnia brasileira, sendo 2480 (49,40%) do sexo feminino e 2540 (50,60%) do sexo masculino, matriculados no Ensino Fundamental (5º a 8º séries) no município de Bauru, SP, independentemente do estágio oclusal ou raça. Durante avaliação, procurou-se classificar, considerando a severidade, em três subtipos: moderado, médio e grave. Para a determinação da prevalência dos portadores de Padrão Face Longa, apenas os indivíduos classificados como subtipos médio e grave foram considerados. Além da estatística descritiva, utilizou-se o teste Qui-quadrado (X2) para comparação das frequências dos indivíduos portadores de comprometimento vertical nas relações faciais por excesso e seus subtipos, e indivíduos Padrão Face Longa entre os diferentes grupos sexuais, adotando-se nível de significância de 5% (p<0,05). Resultados e conclusão: Em ambos os grupos com comprometimento vertical das relações faciais e Padrão Face Longa, houve uma maior prevalência no sexo masculino. Entretanto, a diferença observada deve ser analisada reservadamente em face ao tamanho amostral.

Objective: To investigate the sexual dimorphism in the prevalence of individuals with vertically impaired facial relationships by excess (according to three levels of severity), and especially, of individuals with long face pattern. Methods: The sample consisted of 5020 Brazilian ethnicity subjects: 2480 females (49.40%) and 2540 males (50.60%), enrolled in public and private primary schools (5th to 8th grades) in the city of Bauru, SP, regardless of age, dentition and race. In the survey, individuals were classified into three subtypes according to the severity: mild, moderate and severe. In the survey of long face pattern prevalence, only individuals with moderate and severe level were considered. In addition to descriptive statistics, Chi-square (X2) test was used, at 5% of significance, to compare the frequencies of male and female individuals with vertically impaired facial relationships according to the three levels of severity, and of long face pattern individuals. Results and conclusions: Males were more predominant in both groups of individuals with vertically impaired facial relationships and long face pattern. However, this difference should be analyzed reservedly in accordance to the sample size of each sexual group.

Modificação da técnica laboratorial para confecção do aparelho Herbst / Laboratorial technique modifications for fabrication of Herbst appliance

A partir do final da década de 70, o aparelho desenvolvido em 1906 por Emil Herbst foi reintroduzido na literatura ortodôntica mundial por Hans Pancherz, voltando a ser utilizado progressivamente nos tratamentos das más oclusões do Padrão II em vários estágios de maturidade oclusal. Desde então, diversos protocolos para utilização e variações na confecção laboratorial também têm sido descritos. Este artigo visa a demonstrar as etapas laboratoriais da confecção de um modelo do aparelho Herbst, utilizando como ancoragem superior o expansor tipo Haas e o arco lingual inferior. Adotamos rotineiramente essa variação, que torna o dispositivo mais resistente a quebras e reduz os custos quando comparado ao protótipo original para utilização do mecanismo propulsor...

Tratamento da má oclusão do padrão II, protrusão de maxila, com o aparelho Herbst / Treatment of pattern II malocclusion with maxillary protrusion using Herbest appliance

O presente caso clínico descreve o tatamento, em duas fases, de um paciente Padrão II, protrusão dentária superior e incisivos inferiores bem posicionados, em relação oclusal de Classe II, com apinhamento importante na arcada dentária inferior. Na primeira fase, procedeu-se à expansão rápida da maxila seguida do avanço mandibular contínuo com o aparelho Herbst para correção, respectivamente, das discrepâncias transversal e sagital. Na segunda fase, o aparelho ortodôntico fixo Prescrição II Capelozza em ambas as arcadas, associado à extração de um incisivo inferior, resolveu o apinhamento anterior inferior. O impacto do tratamento foi significativo tanto para a face como para a oclusão e o sorriso.

O efeito da retração dos dentes anteriores sobre o ponto A em pacientes submetidos ao tratamento ortodôntico corretivo / The effect of retraction of anterior teeth on the point A in patients submitted to corrective orthodontic treatment

OBJETIVO: avaliar o efeito da retração anterior sobre o ponto A sagital e verticalmente, bem como a correlação e a previsibilidade do comportamento dessas estruturas. METODOLOGIA: sessenta telerradiografias em norma lateral foram usadas, tomadas no início e no final do tratamento ortodôntico corretivo, a partir de 30 pacientes (22 feminino e 8 masculino) com idade entre 10 e 17 anos antes do tratamento, com má oclusão de Classe II, divisão 1 ou Classe I, que foram submetidos às extrações dos quatro primeiros pré-molares ou somente dois primeiros pré-molares superiores. Além das variáveis .1NA,1-NA, 1.PP e 1-A, mensurações lineares horizontais e verticais foram feitas em relação a uma linha de referência construída a partir da linha SN menos 7º e uma linha perpendicular a ela. Todos os dados foram mensurados duas vezes, e as médias foram submetidas ao teste t emparelhado, de correlação linear e de regressão. RESULTADOS: em média, o ponto A retraiu 0,71mm e movimentou para baixo 2,38mm, seguindo 1,03mm e 4,13mm de retração, respectivamente, do ápice radicular e da borda incisal, e 2,35mm de extrusão dentária. A retração do ponto A apresentou correlação positiva em relação ao ápice radicular (r = 0,75; alfa < 0,0001) e em relação à retração da borda incisal (r = 0,70; alfa < 0,0001), mostrando um comportamento ântero-posterior previsível. CONCLUSÕES: concluiu-se que o ponto A retraiu-se e movimentou-se para baixo seguindo o dente, e a retração do ponto A em relação aos incisivos foi previsível.

OBJECTIVE: it was aimed to evaluate the effect of retraction of anterior teeth on the point A sagittally and vertically, as well as the correlation and the predictability of the behavior of these structures. METHODS: sixty lateral cephalograms were used, which were taken at the beginning and at the end of fixed appliance orthodontic treatment, from thirty patients (22 female and 8 male) aging from 10 to 17 years at baseline, with Class II, Division 1 or Class I malocclusion, who underwent four first premolars extractions or maxillary first premolars extractions only. Besides the variables 1.NA, 1-NA, U1/PP and U1®AVERT, horizontal and vertical linear measurements were made in relation to a horizontal reference line constructed from the S-N plane minus 7º and its perpendicular. As distributed normally, all the data were measured twice, and the mean values were submitted to paired t test, linear correlation and regression tests. RESULTS: in average, point A retracted 0.71mm and moved 2.38mm downwardly, following 1.03mm of root apex and 4.13mm of incisal edge retraction, and 2.35mm of tooth extrusion. The retraction of point A was positively correlated with root apex (r = 0.75; p < 0.0001) and with incisal edge retraction (r = 0.70; p < 0.0001), showing a predictable sagittal behavior. CONCLUSIONS: it was concluded that point A retracted and moved downwardly following the tooth, and the retraction of point A in relation to the incisors was predictable.

Proposta para classificação, segundo a severidade, dos indivíduos portadores de más oclusões do Padrão Face Longa / Proposal for classification of individuals with long face pattern malocclusions according to severity

OBJETIVO: o presente estudo teve como objetivo propor um método para classificação, segundo a severidade, dos indivíduos Padrão Face Longa, avaliando sua confiabilidade e reprodutibilidade. METODOLOGIA: foram utilizadas fotografias faciais (frontal, perfil e frontal sorrindo) de 125 crianças Padrão Face Longa (54 do gênero feminino e 71 do gênero masculino), selecionadas apenas considerando-se a morfologia facial, com idades entre 10 anos e 6 meses e 15 anos e 2 meses. As fotografias foram avaliadas, separadamente, por três examinadores, sendo reavaliadas após três semanas, em uma nova disposição aleatória. Os indivíduos foram graduados em três subtipos, de acordo com a severidade: moderado, médio e severo. Para avaliar as concordâncias intra e interexaminadores, foi utilizada a estatística Kappa (k). RESULTADOS: na avaliação intra-examinador, todos os examinadores obtiveram concordâncias substanciais, com o valor de Kappa variando de 0,64 a 0,66, havendo em todos os examinadores 80 por cento ou mais de concordância. Quando comparadas as avaliações interexaminadores, as freqüências de concordância diminuíram, variando de 67,2 por cento a 70,4 por cento. A partir dos valores de Kappa, que variaram de 0,41 a 0,46, a interpretação foi considerada moderada. CONCLUSÕES: com base nesses resultados, o método foi considerado aplicável, com necessidade de complemento de informações provenientes de outros exames rotineiramente aplicados em Ortodontia. A aplicação clínica será demonstrada com intuito de evidenciar os níveis diferentes de severidade das más oclusões do Padrão Face Longa e as características do protocolo de tratamento recomendado.

AIM: The present study aimed to propose a method for classification of long-face patients according to severity, evaluating its reliability and reproducibility. METHODS: The study was conducted on facial photographs (frontal, profile and smiling frontal) of 125 long-face children (54 females and 71 males) aged 10 years and 6 months to 15 years and 2 months, selected only on the basis of facial morphology. The photographs were separately evaluated by three examiners and re-evaluated after three weeks in a different random order. The individuals were divided into three subtypes according to severity as mild, moderate and severe. Intra- and inter-examiner agreement was assessed by Kappa (k) statistics. RESULTS: Intra-examiner evaluation revealed substantial agreement, with Kappa values ranging from 0.64 to 0.66 and 80 percent or more agreement for all examiners. Evaluation of inter-examiner agreement revealed lower values, ranging from 67.2 percent to 70.4 percent, with Kappa values of 0.41 to 0.46, thus indicating moderate agreement. CONCLUSIONS: Based on these results, the method was regarded as applicable, yet it should be complemented with further information from other examinations routinely applied in Orthodontics. Clinical application will be demonstrated to highlight the different degrees of severity of long face pattern malocclusions and the characteristics of the recommended treatment protocol.

Extrusão ortodôntica com finalidade protética / Orthodontic extrusion for prosthodontic purposes

O objetivo deste trabalho foi evidenciar, por meio de revisão de literatura e relato de caso clínico, problemas relacionados com a invasão do espaço biológico, destacando as vantagens da extrusão ortodôntica associada à cirurgia periodontal para seu restabelecimento