Correlação entre os estágios de maturação da sutura palatina mediana e das vértebras cervicais / Correlation between the maturation stages of the median palatal suture and cervical vertebrae

Introdução: Atualmente, a avaliação da maturação da sutura palatina mediana (MSPM) em pacientes que precisam ser submetidos à expansão rápida da maxila é realizada por meio de tomografias computadorizadas de feixe cônico (TCFC). No entanto, doses adicionais de radiação são induzidas ao paciente para a aquisição desse exame. Objetivo: Correlacionar os estágios de MSPM com os estágios de maturação das vértebras cervicais (MVC). Material e métodos: Um total de 268 TCFC da região da cabeça e do pescoço de indivíduos de ambos os sexos e com idades variando entre 5 e 76 anos foram analisadas de forma cega por uma única examinadora. O estágio de MSPM foi avaliado por meio da observação da maxila no corte axial e foi classificado como A, B, C, D ou E. Por outro lado, o estágio de MVC foi avaliado por meio do corte sagital das vértebras cervicais e foi classificado como CS1, CS2, CS3, CS4, CS5 ou CS6. A concordância intraexaminador foi avaliada por meio do Coeficiente Kappa. O teste de Correlação de Spearman foi utilizado para avaliar a correlação entre os estágios de MSPM e os estágios de MVC. Resultados: Uma correlação positiva forte foi encontrada entre os estágios de MSPM e MVC. Os estágios A e B mostraram correlação com os estágios CS1, CS2 e CS3. Diferentemente, o estágio C se correlacionou com maior frequência com os estágios CS4 e CS5. Por fim, os estágios D e E, se mostraram mais frequentes em indivíduos nos estágios CS5 e CS6 de forma similar. Conclusão: A predição da MSPM por meio da MVC em telerradiografias laterais pode ser uma alternativa viável à avaliação sutural na TCFC em pacientes nos estágios CS1, CS2 e CS3. A partir do estágio CS4, uma TCFC é recomendável para avaliar com maior segurança o estágio de MSPM e definir a melhor modalidade de expansão (AU).

Introduction: Currently, the assessment of maturation of the midpalatal suture (MPSM) in patients who need to undergo rapid maxillary expansion is performed using cone-beam computed tomography (CBCT). However, additional doses of radiation are induced to the patient for the acquisition of this exam. Objective: To correlate the stages of MPSM with the stages of maturation of the cervical vertebrae (CVM). Material and methods: A total of 268 CBCT of the head and neck of individuals of both sexes and aged between 5 and 76 years were analyzed blindly by a single examiner. The MPSM stage was assessed by observing the maxilla in the axial view and was classified as A, B, C, D or E. On the other hand, the CVM stage was assessed in the sagittal view of the cervical vertebrae and was classified as CS1, CS2, CS3, CS4, CS5 or CS6. Intraexaminer agreement was analyzed using the Kappa coefficient. Spearman's Correlation test was used to assess the correlation between MPSM and CVM stages Results: A strong positive correlation was found between MPSM and CVM stages. Stages A and B showed correlation with stages CS1, CS2 and CS3. Differently, stage C correlated more frequently with stages CS4 and CS5. Finally, stages D and E were more frequent in individuals in stages CS5 and CS6, similarly. Conclusion: The prediction of MPSM by assessing CVM in lateral cephalograms seems to be a viable alternative to the sutural evaluation in CBCT in patients in stages CS1, CS2 and CS3. From the CS4 stage onwards, a CBCT is recommended to assess the MPSM stage and define the most adequate expansion modality for patients (AU).

Prevalence of soft tissue calcifications in panoramic radiographs of the maxillofacial region of older adults.

OBJECTIVES: To investigate the presence of soft tissue calcifications in the head and neck region on panoramic radiographs of older adults. METHODS: We analysed 1176 panoramic radiographs obtained between January 2013 and December 2018 from individuals of both sexes aged 60 years or older, who were referred by dental specialities to the Dental Imaginology Service of the Federal University of Rio Grande do Norte, Brazil. The types of soft tissue calcification evaluated were as follows: carotid artery calcification (CAC), thyroid cartilage calcifications, triticeous cartilage calcifications, sialoliths, tonsilloliths and lymph node calcifications. The presence of soft tissue calcifications was correlated with age and sex. The chi-square test with continuity correction was used for the calculation of p values and the evaluation of the proposed associations. Prevalence ratios and 95% confidence intervals were also calculated. RESULTS: At least one type of soft tissue calcification was found in 43% of the sample. The main calcifications detected were CAC, thyroid and triticeous cartilage calcifications, tonsilloliths, sialoliths, calcified lymph nodes, and phleboliths. Mean patient age was 67.47 years and there was a predominance of females (62.8%) in the sample. Bivariate analysis showed a statistically significant association between female sex and the presence of thyroid and triticeous cartilage calcifications and between male sex and the presence of tonsilloliths. CONCLUSION: Routine panoramic radiography permits the identification of soft tissue calcifications that may be indicators of future cardiovascular disorders, the referral to a medical service and the establishment of therapies for stroke prevention.

Capacidade dos ortodontistas em predizer a tendência de crescimento craniofacial a partir da análise morfológica de telerradiografias laterais / Capability of orthodontists to predict craniofacial growth trend using morphological analysis of lateral teleradiographies

Objetivo: Avaliar a capacidade dos ortodontistas em determinar a tendência de crescimento craniofacial pela análise morfológica da telerradiografia lateral. Material e métodos: Três telerradiografias laterais representativas de cada tendência de crescimento (vertical, equilibrado e horizontal) foram selecionadas. As telerradiografias laterais foram digitalizadas e recortadas nas regiões da cabeça da mandíbula, ramo da mandíbula, ângulo goníaco, plano mandibular, chanfradura da mandíbula, sínfise mandibular, plano oclusal e ângulo interincisal. Os recortes e as telerradiografias completas foram distribuídas aleatoriamente em um questionário eletrônico que foi aplicado a 105 profissionais divididos em três grupos de acordo com o tempo de formação como ortodontistas. Os ortodontistas deveriam definir qual a tendência de crescimento que as imagens radiográficas sugeriam, a partir da observação da morfologia das estruturas anatômicas em destaque. Resultados: Os ortodontistas demonstraram grau de concordância pobre para a cabeça da mandíbula na tendência de crescimento horizontal. Uma concordância quase perfeita foi observada para o ângulo goníaco e para o plano mandibular na tendência vertical, para a chanfradura mandibular e para o plano mandibular na tendência horizontal e, quando todas as estruturas anatômicas foram analisadas nas telerradiografias completas. Não houve diferenças significativas na análise morfológica realizada pelos grupos estudados. Conclusão: Os ortodontistas demonstraram diferentes graus de concordância na análise morfológica da telerradiografia lateral, a depender da estrutura anatômica e da tendência de crescimento craniofacial analisada. Implicações clínicas: A predição da tendência de crescimento craniofacial por meio da observação de estruturas anatômicas na telerradiografia lateral parece ser uma ferramenta alternativa de diagnóstico para a análise cefalométrica. (AU)

Objective: To assess orthodontist's capability to predict the craniofacial growth trend by observing the morphology of anatomical structures in lateral cephalograms. Materials and Methods: Three lateral cephalograms representing each growth trend (vertical, balanced, and horizontal) were selected. The lateral cephalograms were digitized and cut in the regions of the mandible head, mandible ramus, gonial angle, mandibular plane, mandibular notch, mandibular symphysis, occlusal plane and interincisal angle in order to centralize the condy- lar process. An electronic questionnaire comprised by the edited images and the complete cephalograms was applied to 105 orthodontists divided into three study groups according to the orthodontic practice time. The orthodontists should define which was the growth trend that the radiographic images suggested by the observation of the anatomic structures highlighted. Results: The orthodontists demonstrated a poor degree of agreement for the mandible head in the horizontal growth trend. An almost perfect agreement was observed for the gonial angle and the mandibular plane in the vertical trend, for the mandibular notch and the mandibular plane in the horizontal trend, and when all anatomic structures were analyzed in complete cephalograms. No significant intergroup differences were observed. Conclusion: The orthodontists showed different degrees of agreement in the morphological analysis of lateral cephalograms depending on the anatomical structure and the craniofacial growth trend analyzed. Clinical implications: Prediction of craniofacial growth trend through observation of anatomical structures on lateral cephalograms seems to be an alternative diagnostic tool for cephalometric analysis.(AU)

Impact of orthognathic surgery on the treatment of gummy smile: an integrative review.

The gingival smile is considered unpleasant and can be treated in different ways according to its etiological factor. When caused by maxillary vertical growth excess, orthognathic surgery may be indicated to correct the vertical excess. The aim of this integrative review was to evaluate the impact of orthognathic surgery on the treatment of gingival smile. An electronic search was performed of the PubMed/Medline, Cochrane Library, Scopus, and Google Scholar databases. The selection of studies was performed by two blinded reviewers. Firstly, studies were selected by reading the titles and the abstracts of articles. The references from each study selected were then searched to find articles that were not found in the electronic search. After reading the full-text articles, studies that met the inclusion criteria were selected. A total of 667 studies were identified, but only 19 were selected for the integrative review after applying the inclusion and exclusion criteria. The selected articles reported maxillary impaction from 2 to 10 mm, but this amount of superior repositioning of maxilla does not appear to be related to the initial gingival exposure described. Orthognathic surgery is not the first choice of treatment for gingival smile, but it appears to be a suitable therapy for other conditions in the same patient for improving a gummy smile by correction of gingival exposure.

Avaliação do nível de concordância entre ortodontistas na análise morfológica para a determinação da tendência de crescimento craniofacial / Assessment of the level of agreement between orthodontists in the morphological analysis to determine the craniofacial growth trend

Introdução: A determinação da tendência de crescimento craniofacial é importante na Ortodontia, uma vez que está diretamente relacionada ao prognóstico do caso. Objetivo: Avaliar o nível de concordância entre ortodontistas na análise morfológica da telerradiografia lateral para a determinação da tendência de crescimento craniofacial. Material e métodos: Foram selecionadas 3 telerradiografias laterais de crianças com idades entre 7 e 11 anos, diagnosticados com relação esquelética e dentária de Classe I. Cada telerradiografia caracterizou uma tendência de crescimento (vertical, equilibrado e horizontal), a qual foi confirmada por meio do traçado do cefalograma e da medição dos ângulos SN.GoGn, SN.Gn, FMA e do índice Vert. As telerradiografias foram recortadas nas regiões da cabeça da mandíbula, ramo da mandíbula, ângulo goníaco, plano mandibular, chanfradura da mandíbula, sínfise mandibular, plano oclusal e ângulo interincisal. Os recortes e as telerradiografias completas foram distribuídas aleatoriamente em um questionário eletrônico que foi aplicado a 105 ortodontistas divididos em três grupos: Grupo 1, composto por ortodontistas com até 1 ano de formação como especialista; Grupo 2, ortodontistas com tempo de formação variando de 1 até 5 anos; e Grupo 3, ortodontistas formados há mais de 5 anos. Os ortodontistas desconheciam a qual telerradiografia pertencia cada recorte e deveriam definir qual a tendência de crescimento que as imagens radiográficas sugeriam. A concordância entre os ortodontistas foi avaliada por meio do Coeficiente de Correlação Interclasse (CCI) e as comparações intergrupos e entre as tendências de crescimento foram realizadas por meio do teste de Kruskal-Wallis, seguido do pós-teste de Dunnett. Resultados: Os ortodontistas demonstraram grau de concordância pobre para a cabeça da mandíbula na tendência de crescimento horizontal. Uma concordância quase perfeita foi observada para a o ângulo goníaco e para o plano mandibular na tendência vertical; para a chanfradura mandibular e para o plano mandibular na tendência horizontal, e quando todas as estruturas anatômicas foram analisadas nas telerradiografias completas. Não houve diferenças significativas na análise morfológica realizada pelos grupos estudados. Conclusão: Os ortodontistas demonstraram diferentes graus de concordância na análise morfológica da telerradiografia lateral, a depender da estrutura anatômica e da tendência de crescimento craniofacial analisada (AU).

Introduction: The importance of determining the craniofacial growth tendency in the field of Orthodontics is due to its relation with the prognosis of a case. Objective: Thus, this research aimed to evaluate the conformity degree amongst orthodontists regarding morphological analysis of lateral teleradiography in order to determine the craniofacial growth tendency. Material and methods: Three lateral radiographs of children aged between 7 and 11 years old and with class I skeletal and dental relationship were selected. Each lateral radiograph featured a different type of growth tendency (vertical, balanced or horizontal), which were confirmed by tracing the cephalogram and measuring the SN.GoGn, SN.Gn and FMA angles and the VERT index. The lateral radiographs were cut in the regions of mandibular head, mandibular ramus, gonial angle, mandibular plane, antegonial notch, mandibular symphysis, occlusal plane and interincisal angle. These cuts as well as the complete versions of the lateral radiographs were randomly included into an electronic questionnaire applied for 105 orthodontists that were divided into three different groups: group 1 was composed of orthodontists with up to 1 year as specialists, group 2 was constituted by orthodontists whose graduation was concluded in between 1 and 5 years, and group 3 was formed by orthodontists who have graduated in more than 5 years. At first, the orthodontists were not aware of which cut belonged to each radiograph and so the orthodontists should define the growth tendency suggested by the images. The conformity degree was measured using Intraclass Correlation Coefficient (ICC) and the comparisons between the groups and between growth tendencies were evaluated using Kruskal-Wallis test, followed by the post test of Dunnet. Results: The orthodontists demonstrated a poor degree of conformity for the jaw head in the tendency of horizontal growth. Nevertheless, an almost-perfect conformity degree was observed for the gonial angle and mandibular plane in the vertical tendency as well as for the antegonial notch and mandibular plane in the tendency of horizontal growth and also when all anatomic structures were analyzed in the complete lateral radiographs. Therefore, significant discrepancies in the morphological analysis performed by the studied groups were not observed. Conclusion: In conclusion, the orthodontists demonstrated different degrees of conformity in the morphological analysis of lateral radiograph depending on the anatomical structure and the analyzed tendency of craniofacial growth (AU).