A new way of analyzing tooth movement using universal coordinate system geometry single point superposition in a 3D model.

INTRODUCTION: Superposing 3D models is an imminent need. However, current methods rely on marking multiple points on the maxilla and mandible, which could increase point marking and overlapping errors. OBJECTIVE: This study aimed at developing a method for superimposing 3D models of the maxillary and mandibular arches with Autodesk Inventor® engineering software, using a single universal coordinate system (UCS) point superposition. METHODS: A total of 104 STL (stereolithography) models of the maxillary and mandibular arches exported from My iTero® platform were retrospectively selected, in which T0 and T1 were the initial and refinement periods, respectively (n=26 per group). The X, Y, and Z coordinates associated with a single point in each arch were inserted into the models with SlicerCMF® software for model orientation. The arch models with UCS registration were transferred to Autodesk Inventor® for superimposition and to measure tooth movements performed during Invisalign® treatment. Arch expansion, intrusion and rotation were analyzed by two examiners. The statistics were performed using intraclass correlation coefficients (ICC), Dahlberg's formula, and t-test (p<0.05). RESULTS: A reliable method of superimposing 3D digital models using a single UCS point in the maxilla and mandible was developed. ICC showed excellent intra- and inter-examiner correlation (ICC>0.90). A systematic error was not found concerning linear and angular measurements (<1mm and <1.5°, respectively). Digital dental movements could be analyzed, including arch expansion, dental intrusion, and tooth rotation. CONCLUSIONS: The developed method was proven reliable and reproducible for superimposing 3D models of the maxillary and mandibular arches by using UCS system.

A new way of analyzing tooth movement using universal coordinate system geometry single point superposition in a 3D model

ABSTRACT Introduction: Superposing 3D models is an imminent need. However, current methods rely on marking multiple points on the maxilla and mandible, which could increase point marking and overlapping errors. Objective: This study aimed at developing a method for superimposing 3D models of the maxillary and mandibular arches with Autodesk Inventor® engineering software, using a single universal coordinate system (UCS) point superposition. Methods: A total of 104 STL (stereolithography) models of the maxillary and mandibular arches exported from My iTero® platform were retrospectively selected, in which T0 and T1 were the initial and refinement periods, respectively (n=26 per group). The X, Y, and Z coordinates associated with a single point in each arch were inserted into the models with SlicerCMF® software for model orientation. The arch models with UCS registration were transferred to Autodesk Inventor® for superimposition and to measure tooth movements performed during Invisalign® treatment. Arch expansion, intrusion and rotation were analyzed by two examiners. The statistics were performed using intraclass correlation coefficients (ICC), Dahlberg's formula, and t-test (p<0.05). Results: A reliable method of superimposing 3D digital models using a single UCS point in the maxilla and mandible was developed. ICC showed excellent intra- and inter-examiner correlation (ICC>0.90). A systematic error was not found concerning linear and angular measurements (<1mm and <1.5°, respectively). Digital dental movements could be analyzed, including arch expansion, dental intrusion, and tooth rotation. Conclusions: The developed method was proven reliable and reproducible for superimposing 3D models of the maxillary and mandibular arches by using UCS system.

RESUMO Introdução: A sobreposição de modelos 3D é uma necessidade iminente. No entanto, os métodos atuais dependem da marcação de múltiplos pontos na maxila e na mandíbula, o que pode aumentar a incorporação de erros no processo de sobreposição. Objetivo: O objetivo desse estudo foi desenvolver um método para sobrepor modelos 3D das arcadas superior e inferior utilizando o software de engenharia Autodesk Inventor®, por meio da marcação de um único ponto em cada arcada, usando o sistema de coordenadas universal (UCS). Métodos: No total, 104 modelos STL das arcadas superior e inferior exportados da plataforma My iTero® foram selecionados retrospectivamente, onde T0 foi o período inicial e T1, o de refinamento (n=26 por grupo). As coordenadas X, Y e Z associadas a um único ponto em cada arcada foram inseridas nos modelos usando o software SlicerCMF®. Os modelos com os pontos UCS demarcados foram transferidos para o software Autodesk Inventor® para realizar a sobreposição e medir os movimentos dentários realizados durante o tratamento com Invisalign®. Os movimentos de expansão, intrusão e rotação foram analisados por dois examinadores. A análise estatística foi realizada usando os coeficientes de correlação intra-classe (ICC), fórmula de Dahlberg e teste t (p<0,05). Resultados: Foi desenvolvido um método confiável de sobreposição de modelos digitais 3D usando um único ponto UCS na maxila e mandíbula. O ICC apresentou excelente correlação intra e inter-avaliadores (ICC>0,90). Não foi encontrado erro sistemático nas medidas lineares e angulares (<1mm e <1,5°, respectivamente). Os movimentos dentários puderam ser analisados por meio do método proposto, incluindo expansão da arcada, intrusão e rotação dentária. Conclusão: O método desenvolvido provou ser confiável e reprodutível para sobreposição de modelos 3D das arcadas superior e inferior usando o sistema UCS com marcação de ponto único.

Thresholds of Identification and Aesthetic Perception of Simulated Alar Base Widening Among Oral and Maxillofacial Surgeons: an Online Questionnaire-Based International Study / Limiares de Identificação e Percepção Estética do Alargamento Simulado da Base Alar Entre Cirurgiões Buco-Maxilo-Faciais: um Levantamento Internacional

This study aimed to compare the thresholds of identification and aesthetic perception of simulated alar base widening among oral and maxillofacial (OMF) surgeons from Brazil and other countries through an online data collection form. Photographs of one male and one female model were digitally manipulated to obtain aesthetically acceptable, symmetrical faces and to gradually widen the alar base to produce six different images from each original photograph. The online questionnaire was sent to OMF surgeons of different nationalities. The results mshowed that the majority of Brazilian (88%) and international (89%) evaluators considered the female faces with 0 to 2 mm of alar base widening as being more pleasant. In turn, Brazilian (93%) and international (94%) respondents agreed that faces with the greatest widening (8 and 10 mm) were less pleasant. As for the male model, Brazilian (93%) and international (85%) OMF surgeons agreed that faces with none or small widening (0 and 2 mm) were more pleasant. The male face with the greatest widening (10 mm) was considered the least attractive by the respondents (93% in both groups). The findings of this study suggest that alar base widening up to the limit of 2 mm did not alter the perception of facial attractiveness. Thus, faces without alar base widening were considered the most attractive, while those with significant alterations were considered less attractive. Most importantly, despite the limitations of this study design, it seems that different cultural and professional contexts have minor influence on aesthetics analysis performed by OMF surgeons. (AU)

Este estudo teve como objetivo comparar os limiares de identificação e percepção estética do alargamento simulado da base alar entre cirurgiões bucomaxilofaciais (BMF) do Brasil e de outros países por meio de um formulário de coleta de dados online. Fotografias de um modelo masculino e de uma modelo feminina foram manipuladas digitalmente para obter faces esteticamente aceitáveis e simétricas e para ampliar gradualmente a base alar produzindo seis imagens diferentes de cada fotografia original. O questionário online foi enviado aos cirurgiões BMF de diferentes nacionalidades. Os resultados mostraram que a maioria dos avaliadores brasileiros (88%) e internacionais (89%) consideraram as faces femininas com 0 a 2 mm de alargamento da base alar como mais agradáveis. Por sua vez, os entrevistados brasileiros (93%) e internacionais (94%) concordaram que os rostos com maior alargamento (8 e 10 mm) foram os menos agradáveis. Quanto ao modelo masculino, os cirurgiões brasileiros (93%) e internacionais (85%) da OMF concordaram que faces com nenhum ou pequeno alargamento (0 e 2 mm) eram mais agradáveis. A face masculina com maior alargamento (10 mm) foi considerada a menos atraente pelos entrevistados (93% em ambos os grupos). Nossos achados sugerem que o alargamento da base alar até o limite de 2 mm não alterou a percepção da atratividade facial. Assim, rostos sem alargamento da base alar foram considerados os mais atraentes, enquanto aqueles com alterações significativas foram considerados menos atraentes. Mais importante ainda, apesar das limitações, parece que diferentes contextos culturais e profissionais têm pouca influência na análise estética realizada pelos cirurgiões da OMF. (AU)

About chin (genioplasty) surgery / Sobre cirugía del mentón (genioplastía)

Facial harmony is the consequence of a proper balance between all facial structures. The identification and classification of morphologic characteristics that detract from facial harmony is most effectively accomplished by clinical examination. The maintenance of the ratios between the facial thirds, correct spatial bone position and soft tissues accommodation are all factors that directly contribute in a balanced facial profile. The chin, likewise, contributes significantly in facial balance, mainly in the profile view. Expressive changes on chin position are associated with the perception of strong or delicate characters. Thus, over the years, a series of studies has been constructed focusing on mandibular osteotomies techniques that enable changes in chin position: advances, setback, extrusion, intrusion, widening, narrowing and asymmetry. This study aims to address historical and technical aspects of genioplasty; associating patient's condition with the surgical techniques that can be applied for correction of chin deformities.

La armonía facial es la consecuencia del balance entre las estructuras facial. La identificación y clasificación de las características morfológicas que están acompañando la armonía facial son mas efectivas al realizar un estudio de análisis facial. La obtención de promedios entre los tercios, corrección especial de la posición del hueso y la acomodación de los tejidos blandos son factores directamente involucrados en el balance del perfil. El mentón, contribuye significativamente en este balance. Cambios expresivos en la posición del mentón son asociados con la percepción de características fuertes o delicadas. Durante los años, una serie de estudios han sido desarrollados enfocándose en las osteotomías mandibulares y técnicas capaces de alcanzar los cambios en la posición del mentón: avances, retrocesos, extrusiones, ensanchamientos, estrechamientos y asimetrías. Este estudio pretende orientar las condiciones históricas y técnicas respecto de la genioplastia; la asociación de las características del paciente con la técnica quirúrgica pueden ser aplicadas para la corrección de las deformidades.

Sensorial Ability, Mastication and Nutrition of Single-Implant Overdentures Wearers.

The use of two-implant overdentures improves mastication of edentulous elderly patients. However, little is known about the effects of single-implant overdentures (SIO) on oral perception and masticatory function in such elders. This study compared the effects of conventional complete dentures (CD) and SIO on the oral sensorimotor ability (OSA), masticatory function, and nutritional intake of elderly people with residual alveolar mandibular height classified as Class III or IV according to the American College of Prosthodontics. Twelve elders first received new conventional CD, which were later converted to SIO. All variables were evaluated after use of each prosthesis for 2 months. To evaluate OSA, elders closed their eyes and orally identified test pieces prepared from raw carrots. A kinesiographic device was used to measure chewing movements during mastication of a test material (Optocal). Masticatory performance (MP) was determined with the sieving method, and a 3-day food diary verified nutrient intake based on a standard Brazilian Food Composition Table. Data were analyzed using the Wilcoxon signed rank test and Student's paired t test (P < 0.05). OSA results did not differ according to prosthesis type. However, opening and closing velocities during chewing and MP increased after SIO insertion (P < 0.05). Although no difference was observed in the intake of most nutrients, sodium ingestion decreased after SIO insertion (P < 0.05). SIO use had no effect on OSA, but significantly improved mastication and sodium intake of elders with decreased residual ridges height (Brazilian Registry of Clinical Trials #RBR-3kgttj).

Reduction mandibuloplasty for facial aesthetic enhancement in western women - a case report / Mandibuloplastia de redução para melhoria estética facial na mulher ocidental - relato de caso

This paper reports on the case of a Western female patient with square jaw and low mandibular angle deformity who sought treatment for aesthetic facial enhancement. While face-narrowing surgical procedures are especially popular among Asian women, there seems to be a general, cross-cultural agreement that a beautiful female face should be oval and slender. Under general anesthesia, intra-oral incisions were performed bilaterally to approach the mandibular angles. After periosteal elevation, bilateral corticectomies of the mandibular rami and "V" ostectomies of the mandibular base were executed. Postoperative recovery was uneventful. Six months after surgery, the patient's face was not only rounder and gentler in the frontal view, but also showed an evident increase of the gonial angles in the profile and three-quarter views.

Este trabalho relata o caso de uma paciente ocidental do sexo feminino com "face quadrada" e ângulo mandibular baixo que procurou tratamento para o aprimoramento estético facial. Embora procedimentos cirúrgicos que produzem um rosto mais estreito sejam especialmente populares entre mulheres asiáticas, parece haver um consenso geral e transcultural com relação às características de um rosto feminino bonito, que tende a ser oval e afilado. Sob anestesia geral, realizou-se incisões intra-orais para abordagem dos ângulos mandibulares. Após a elevação do periósteo, executou-se corticectomias das faces laterais dos ramos mandibulares e ostectomias em "V" das bordas inferiores da mandíbula. Não houve complicação pós-operatória. Seis meses após a cirurgia, a face da paciente mostrava-se não só mais arredondada e delicada na vista frontal, mas também com um aumento evidente dos ângulos goníacos nas vistas lateral e oblíqua.

Remoção de dente deslocado para o espaço bucal / Removal of a tooth displaced into the buccal space

A remoção cirúrgica de terceiros molares impactados é um procedimento cirúrgico comum, que pode ser realizado tanto por dentistas generalistas como por cirurgiões buco-maxilo-faciais. O deslocamento dental para espaços fasciais contíguos, entretanto, é um acidente relativamente raro, associado a exames clínico-radiográficos inadequados, à falta de conhecimentos da anatomia local, a acessos cirúrgicos inadequados, à visibilidade limitada e a movimentos cirúrgicos excessivos ou descontrolados.Embora a remoção de um dente deslocado seja normalmente realizada tardiamente, e, após estudos clínico-radiográficos minuciosos, resgates imediatos também são uma possibilidade. O objetivo deste trabalho é descrever o manejo de um terceiro molar superior deslocado acidentalmente para o espaço bucal após tentativa de exodontia... (AU)

The removal of impacted third molars is a common surgical procedure that may be performed by general dentists and oral and maxillofacial surgeons alike. Tooth displacement into contiguous fascial spaces, however, is a rather uncommon surgical mishap that is associated with inadequate clinical and radiographic examination, lack of sound anatomical knowledge, inadequate surgical access, limited visibility and excessive or uncontrolled surgical movements. While the removal of a displaced tooth is normally performed after thorough clinical and radiographic assessments in a mediate fashion, immediate surgical rescue is also a possibility. The aim of this paper is to describe the management of an upper third molar accidentally displaced into the buccal space after an attempt to extract... (AU)

Comparação dos fatores de risco e complicações da síndrome coronariana aguda entre pacientes com idade superior ou igual a 65 anos e aqueles com menor idade / Comparison of risk factors and complications of the acute coronary syndrome in patients aged over or equal to 65 years and those with younger age

Objetivo. Analisar os principais fatores de risco de síndrome coronariana aguda e as complicações mais frequentes em pacientes com idade igual ou superior a 65 anos hospitalizados em unidade de terapia intensiva, inclusos os casos de óbito após o evento coronariano. Método. Estudo retrospectivo, de revisão de prontuários de 740 pacientes admitidos com síndrome coronariana aguda na unidade de terapia intensiva do Hospital Santa Lúcia, Brasília, DF, no período de outubro de 2003 a fevereirode 2009. Compararam-se os dados dos 377 (51%) pacientes com idade igual ou superior a 65 anos com aqueles dos 363 (49%) pacientes com menos de 65 anos, com os testes qui ao quadrado ou exato de Fisher e Mann-Whitney. Considerou-se estatisticamente significante o valor de p ? 0,05. Resultados. Os portadores de síndrome coronariana aguda com idade igual ou superior a 65 anos, em relação àqueles com idade inferior a 65 anos, apresentam, com mais frequência, infarto agudo do miocárdio sem supradesnivelamento do segmento ST (p = 0,001), hipertensão arterial sistêmica (p = 0,009), diabetes melito tipo 2 (p < 0,0001), insuficiência renal crônica (p = 0,04), antecedente de acidente vascular encefálico (p = 0,01), arritmias (p = 0,01), insuficiênciacardíaca congestiva (0,01) e óbito (p < 0,0001). Conclusões. Houve diferença entre os fatores de risco com relação à idade. A hipertensão arterial sistêmica e o diabetes foram prevalentes na faixa etária igual ou acima dos 65 anos. Esses doentes têm seu curso hospitalar frequentemente acompanhado de complicações, principalmente arritmias e insuficiência cardíaca congestiva. O índice de mortalidadefoi maior nos pacientes com 65 anos de idade ou acima.

Objective. To analyze the risk factors for acute coronary syndrome and the complications in patients aged over or equal to 65 years hospitalized in an intensive care unit, including the mortality after coronary event.Method. Retrospective data collection with 740 patients admitted with acute coronary syndrome in an intensive care unit of Hospital Santa Lucia (Brasilia-DF, Brazil), from October 2003 to February 2009. Comparative analysis between the group of 377 (51%) patients aged over or equal to 65 years, and 363 (49%) patients younger than 65 yearswere performed. Data collection was based on the records, exams and interviews with patients or family members. Results. Patients aged over or equal to 65 years with acute coronary syndrome often have acute myocardial infarction without ST-segment elevation (p = 0.001), hypertension (p = 0.009), type 2 diabetes mellitus (p <0.0001), chronicrenal failure (p = 0.04), previous stroke (p = 0.01), arrhythmias (p = 0.01), congestive heart failure (0.01) and death (p <0.0001). Conclusions. There were differences of risk factors with age. High blood pressure and diabetes mellitus were prevalent in patients aged over or equal to 65 years. These patients have their hospital course frequently accompaniedby complications, especially arrhythmias, congestive heart failure. The mortality rate was higher in patients aged over or equal to 65 years.

The use of herbal medicine in Alzheimer's disease-a systematic review.

The treatments of choice in Alzheimer's disease (AD) are cholinesterase inhibitors and NMDA-receptor antagonists, although doubts remain about the therapeutic effectiveness of these drugs. Herbal medicine products have been used in the treatment of Behavioral and Psychological Symptoms of Dementia (BPSD) but with various responses. The objective of this article was to review evidences from controlled studies in order to determine whether herbs can be useful in the treatment of cognitive disorders in the elderly. Randomized controlled studies assessing AD in individuals older than 65 years were identified through searches of MEDLINE, LILACS, Cochrane Library, dissertation Abstract (USA), ADEAR (Alzheimer's Disease Clinical Trials Database), National Research Register, Current Controlled trials, Centerwatch Trials Database and PsychINFO Journal Articles. The search combined the terms Alzheimer disease, dementia, cognition disorders, Herbal, Phytotherapy. The crossover results were evaluated by the Jadad's measurement scale. The systematic review identified two herbs and herbal formulations with therapeutic effects for the treatment of AD: Melissa officinalis, Salvia officinalis and Yi-Gan San and BDW (Ba Wei Di Huang Wan). Ginkgo biloba was identified in a meta-analysis study. All five herbs are useful for cognitive impairment of AD. M. officinalis and Yi-Gan San are also useful in agitation, for they have sedative effects. These herbs and formulations have demonstrated good therapeutic effectiveness but these results need to be compared with those of traditional drugs. Further large multicenter studies should be conducted in order to test the cost-effectiveness of these herbs for AD and the impact in the control of cognitive deterioration.