Germenectomía de los terceros molares con cefalometría predictiva de brote

Introducción: Las complicaciones, asociadas al brote anormal de los terceros molares, es posible evitarlas con la germenectomía de estos dientes. Objetivo: Caracterizar la evolución de la germenectomía de terceros molares en pacientes con diagnóstico cefalométrico de brote anormal. Métodos: Se realizó un estudio observacional, descriptivo y transversal en el Servicio de Cirugía Maxilofacial del Hospital Provincial "Saturnino Lora Torres", desde febrero de 2019 hasta marzo de 2021. Se estudiaron 32 pacientes de 13 a 15 años de edad, interviniéndose quirúrgicamente 78 terceros molares. Las variables fueron edad, sexo, color de la piel, localización y posición del tercer molar; así como las complicaciones trans y posoperatorias y la evolución. Resultados: Entre los 32 pacientes incluidos en el estudio predominó el sexo femenino (62,5 %) y la edad de 14 años (40,6 %). Las complicaciones ocurridas durante la germenectomía fueron más frecuentes en la arcada inferior. Aunque no fueron detectadas diferencias estadísticamente significativas según localización (valor de p>0,05); con 30 transoperatorias para un 38,4 % y 75 posoperatorias para un 96,2 %. Conclusiones: Se evidencia una evolución marcadamente favorable posterior a la germenectomía de terceros molares en la población de pacientes con diagnóstico cefalométrico de brote anormal. En ellos el sangrado transoperatorio y el dolor posoperatorio constituyen las complicaciones a considerar en este tipo de procedimiento quirúrgico.

Introduction: Complications associated with the abnormal eruption of third molars can be avoided with germenectomy of these teeth. Objective: To characterize the evolution of third molar germenectomy in patients with a cephalometric diagnosis of abnormal bud. Methods: An observational, descriptive and cross-sectional study was carried out in the Maxillofacial Surgery Service at Saturnino Lora Torres Provincial Hospital, from February 2019 to March 2021. Thirty two patients aged 13 to 15 years were studied, with 78 third molars undergoing surgery. The variables were age, sex, skin color, location and position of the third molar; as well as trans and postoperative complications and evolution. Results: Among the 32 patients included in the study, the female sex (62.5%) and the age of 14 years (40.6%) predominated. Complications that occurred during germenectomy were more frequent in the lower arch. Although no statistically significant differences were perceived according to location (p value > 0.05); with 30 intraoperative for 38.4% and 75 postoperative for 96.2%. Conclusions: There is evidence of a markedly favorable evolution after germenectomy of third molars in the population of patients with cephalometric diagnosis of abnormal bud. In them, transoperative bleeding and postoperative pain are the complications to consider in this type of surgical procedure.

Upper airway assessment in obstructive sleep apnea patients: can computed tomography with lateral cephalometry replace drug-induced sleep endoscopy (DISE)? / Evaluación de la vía aérea superior en pacientes con apnea obstructiva del sueño: ¿puede la tomografía computarizada con cefalometría lateral reemplazar endoscopia del sueño inducida por fármacos por fármacos?

Objective To evaluate the association between results from drug-induced sleep endoscopy (DISE) and computed tomography with lateral cephalometry (CTLC) of the pharynx in obstructive sleep apnea (OSA) patients, regarding the same anatomic level, in order to understand if CTLC could replace DISE in selected patients. Study design Cross-sectional. Setting Tertiary hospital. Methods A total of 71 patients who attended the Sleep Medicine Consultation in the Otorhinolaryngology Department of Hospital CUF Tejo between 1.6.2019 and 30.9.2021, performed a polysomnographic sleep study and were elected to undergo DISE and CTLC of the pharynx for diagnostic purposes were selected. Obstructions at the same anatomic levels – tongue base, epiglottis and velum - were compared in both exams. Results Patients with reduction of epiglottis-pharynx space on CTLC had also a complete obstruction at epiglottis level on the VOTE classification of DISE (p = 0,027). Reduction of velum-pharynx space or tongue base-pharynx space were not related to complete obstruction of the velum (P = 0,623) or the tongue base (p = 0,594) found in DISE. Those with two or more space reductions had a tendency to multilevel obstruction observed in DISE (p = 0.089). Conclusion When evaluating the obstruction level(s) of an OSA patient, efforts should be made to perform DISE, since CTLC measures, though regarding at the same structures, don´t correlate completely with obstructions observed in DISE. (AU)

Objetivo Evaluar la asociación entre los resultados de la endoscopia del sueño inducida por fármacos (DISE) y la tomografía computarizada con cefalometría lateral (TCCL) de faringe en pacientes con apnea obstructiva del sueño (AOS), en el mismo nivel anatómico, para comprender si la TCCL podría reemplazar DISE en pacientes seleccionados. Diseño del estudio Transversal. Lugar Hospital de tercer nivel. Métodos Un total de 71 pacientes que acudieron a la Consulta de Medicina del Sueño en el Servicio de Otorrinolaringología del Hospital CUF Tejo entre el 1.6.2019 y el 30.9.2021, a los que se les había realizado un estudio polisomnográfico del sueño y fueron elegidos para realizar DISE y TCCL de faringe con fines diagnósticos, fueron seleccionados. Las obstrucciones en los mismos niveles anatómicos (base de la lengua, epiglotis y velo) se compararon en ambos exámenes. Resultados Los pacientes con reducción del espacio epiglotis-faringe en TCCL también tenían una obstrucción completa a nivel de epiglotis en la clasificación VOTE de DISE (p = 0,027). La reducción del espacio velo-faringe o base de la lengua-faringe no se relacionó con la obstrucción completa del velo (P = 0,623) o de la base de la lengua (p = 0,594) encontrada en DISE. Aquellos con dos o más reducciones de espacio presentaron tendencia a la obstrucción multinivel observada en DISE (p = 0,089). Conclusión Al evaluar el o los niveles de obstrucción de un paciente con AOS, se debe intentar realizar DISE, ya que las medidas de TCCL, aunque se refieren a las mismas estructuras, no se correlacionan completamente con las obstrucciones observadas en DISE. (AU)

Cephalometric Characteristics in Chilean Latino Population with Normal Occlusion and Harmonic Profiles in Permanent Dentition. A Retrospective Study / Características Cefalométricas en Población Latina Chilena con Oclusión Normal y Perfiles Armónicos en Dentición Permanente. Un Estudio Retrospectivo

SUMMARY: Malocclusion is usually treated based on clinical decisions complemented with a cephalometric analysis, allowing the comparison of an individual with standard reference norms. Cephalometric standards have mostly been obtained from Caucasian population, but may not be appropriate for other ethnic groups, becoming a clinically relevant problem in multicultural and multiracial societies. The present study aimed to establish cephalometric norms for Chilean-Latino population, using a representative sample of class I individuals in permanent dentition. A sample of 72 cephalometric x-rays of class I growing individuals (47 women and 25 men) between 10 and 20 years of age with class I occlusion and harmonic profile was obtained from the records of the Universidad de los Andes taken between 2012 and 2019, including 1164 individuals. The radiographs were classified according to their cervical vertebral maturation status, and cephalometrically analyzed, obtaining vertical and sagittal parameters in soft and hard tissues, which were compared with Caucasian cephalometric norms. The statistical analysis was performed using descriptive and inferential statistics (T-test, ANOVA and Bonferroni tests). Cephalometric norms were obtained for hard and soft tissues. Upon comparison with Caucasian norms, the subjects included in the sample present a tendency towards a convex profile, significant incisal proclination, dental protrusion, labial biprotrusion and an acute nasolabial angle. There are cephalometric differences between the Caucasian cephalometric norms and those observed Chilean Latino population, displaying differences at a hard and soft tissue level that should be taken into account for clinical decision making in Orthodontics.

La maloclusión generalmente se trata con base en decisiones clínicas complementadas con un análisis cefalométrico, lo que permite la comparación de un individuo con normas de referencia estándar. Los estándares cefalométricos se han obtenido en su mayoría de población caucásica, pero pueden no ser apropiados para otros grupos étnicos, convirtiéndose en un problema clínicamente relevante en sociedades multiculturales y multirraciales. El presente estudio tuvo como objetivo establecer normas cefalométricas para población chileno-latina, utilizando una muestra representativa de individuos clase I en dentición permanente. Se obtuvo una muestra de 72 radiografías cefalométricas de individuos en crecimiento clase I (47 mujeres y 25 hombres) entre 10 y 20 años de edad con oclusión clase I y perfil armónico de los registros de la Universidad de los Andes tomados entre 2012 y 2019, incluidas 1164 personas. Las radiografías se clasificaron según su estado de maduración vertebral cervical, y se analizaron cefalométricamente, obteniendo parámetros verticales y sagitales en tejidos blandos y duros, que se compararon con normas cefalométricas caucásicas. El análisis estadístico se realizó mediante estadística descriptiva e inferencial (T-test, ANOVA y pruebas de Bonferroni). Se obtuvieron normas cefalométricas para tejidos duros y blandos. En comparación con las normas caucásicas, los sujetos incluidos en la muestra presentan una tendencia hacia un perfil convexo, proinclinación incisal significativa, protrusión dental, biprotrusión labial y un ángulo nasolabial agudo. Existen diferencias entre las normas cefalométricas caucásicas y las observadas en población latina chilena, mostrando diferencias a nivel de tejidos duros y blandos que se deben considerar para la toma de decisiones clínicas en Ortodoncia.

Concordance of the vestibular bone thickness at the level of point a between teleradiography and cone beam computed tomography / Concordancia del espesor óseo vestibular a nivel del punto a entre telerradiografía y tomografía computarizada de haz cónico

Objective: The aim of this study was to determine the concordance of the vestibular bone thickness measured at the level of point A between Teleradiography and Cone Beam Computed Tomography (CBCT). Materials and Methods: This study consisted of a cross-sectional analytical design of concordance that evaluated the teleradiographies and CBCTs of 32 patients. The measurements were performed by three evaluators, specialists in orthodontics. Two of them measured the CBCTs and one evaluated the teleradiographs. The concordance of both tests was determined using the Concordance Correlation Coefficient. Results: When evaluating the value of the vestibular bone thickness at the level of point A between the CBCT and the teleradiography, it was observed that the mean value of the absolute difference between the two was 0.95±0.74, 95%CI [0.68­1.22], being statistically significant (p=0.0027). When the concordance between both tests was analyzed, it was observed that it was poor (CCC=0.204 95%CI [0.014­0.394]), although statistically significant (p<0.00001). Conclusions: It was possible to conclude that there is no concordance in the measurement of the vestibular bone thickness at the level of Point A between the Teleradiography and the CBCT.

Objetivo: El objetivo de este estudio fue determinar la concordancia del espesor óseo vestibular medido a nivel del punto A entre la Telerradiografía y la Tomografía computarizada de haz cónico (CBCT). Materiales y Métodos: Esta investigación presentó un diseño analítico transversal de concordancia en el que se evaluaron las telerradiografías y CBCT de 32 pacientes. Las mediciones fueron realizadas por tres evaluadores especialistas en ortodoncia, dos de ellos midieron los CBCT y uno las telerradiografías. La concordancia de ambos exámenes fue medida mediante Coeficiente de Correlación de Concordancia. Resultados: Al evaluar el valor del grosor óseo vestibular a nivel del punto A entre el CBCT y la telerradiografía, se observó que el valor promedio de diferencia absoluta entre ambos fue de 0,95±0,74 IC95% [0,68­1,22], siendo estadísticamente significativas (p=0,0027). Cuando se analizó la concordancia entre ambos exámenes se observó que esta fue pobre (CCC=0,204 IC95 % [0,014­0,394]), aunque estadísticamente significativa (p<0,00001). Conclusión: Se pudo concluir que no existe concordancia en la medición del espesor óseo vestibular medido a nivel del Punto A entre la Telerradiografía y el CBCT.

Relationship between the occlusal plane and three different levels of ala-tragus line in a sample of sudanese adults / Relación entre el plano oclusal y tres niveles diferentes de la línea ala-trago en una muestra de adultos sudaneses

Aim: Correct orientation of the occlusal plane plays a vital role in achieving the perfect occlusal balance and function of complete dentures. This study aimed to evaluate the most reliable posterior reference point of the ala-tragus line (ATL) concerning occlusal plane (OP) in a sample of the dentate Sudanese population. Materials and Methods: A total of 150 subjects with healthy and well-aligned permanent teeth were randomly selected. Right lateral profile photographs were taken with subjects having a fox plane placed intra-orally, contacting the occlusal plane. Reference points corresponding to inferior, middle, and superior borders of the tragus and inferior border of the ala of the nose were marked on photographs. The angles between the lines were measured using the Auto-CAD software program, and the most parallel relationship was determined. Descriptive statistics in terms of means and standard deviations were presented. Independent t-test and one-way ANOVA tests were used to compare as appropriate. A p-value < 0.05 was considered significant. Results: The mean angle formed by the OP and ATL was 8.5±3.69º for the superior level, 4.68±3.13º for the middle line, and 2.89±2.57º for the inferior line. A significant difference was found between the means of the three angles (p< 0.001), while no significant difference (p> 0.05) was found between both genders regarding the measured angles. Conclusions: The line joining the inferior border of the ala of the nose with the inferior border of the tragus of the ear was the most reliable line in terms of parallelism to determine the occlusal plane orientation.

Antecedentes: La orientación correcta del plano oclusal juega un papel vital para lograr el equilibrio oclusal perfecto y la función de las prótesis completas. Este estudio tuvo como objetivo evaluar el punto de referencia posterior más confiable de la línea ala-trago (ATL) con respecto al plano oclusal (OP) en una muestra de la población dentada de Sudán. Materiales y Métodos: Se seleccionaron aleatoriamente un total de 150 sujetos con dientes permanentes sanos y bien alineados. Se tomaron fotografías de perfil lateral derecho de sujetos a los que se les colocó un plano de zorro intraoralmente, en contacto con el plano oclusal. En las fotografías se marcaron los puntos de referencia correspondientes a los bordes inferior, medio y superior del trago y al borde inferior del ala de la nariz. Los ángulos entre las líneas se midieron utilizando el programa de software Auto-CAD y se determinó la relación más paralela. Se presentaron estadísticas descriptivas en términos de medias y desviaciones estándar. Se utilizaron prueba-t independiente y prueba ANOVA unidireccional para las comparaciones, según correspondiera. Se consideró significativo un valor de p<0,05. Resultados: El ángulo medio formado por OP y ATL fue de 8,5±3,69º para el nivel superior, 4,68±3,13º para la línea media y 2,89±2,57º para la línea inferior. Se encontró una diferencia significativa entre las medias de los tres ángulos (p< 0,001), mientras que no se encontró diferencia significativa (p>0,05) entre ambos sexos con respecto a los ángulos medidos. Conclusión: La línea que une el borde inferior del ala de la nariz con el borde inferior del trago de la oreja fue la línea más confiable en términos de paralelismo para determinar la orientación del plano oclusal.

Craniofacial abnormalities and malocclusion findings in sickle cell disease related to ethnic-racial populations: a critical review of the literature

Introduction: sickle Cell Disease (SCD) is an inherited, hematological, chronic disease that mostly affects racial/ethnic groups. The dental literature discusses SCD's oral symptoms, such as malocclusion and craniofacial abnormalities, without considering the significance of a racial/ethnic perspective. Objective: this article critically reviewed the findings of the studies based on a racial/ethnic standpoint and SCD landmarks. Sources of data: primary and secondary searches selected 146 studies from four scientific literature databases. Two reviewers independently extracted data from eleven included studies. Synthesis of data: most studies used lateral cephalometry and reported craniofacial abnormalities and malocclusions, such as maxillary protrusion, class II skeletal patterns, vertical facial growth patterns, convex facial profile, mandibular retrusion, and the posterior rotation of the jaw. However, there is no mention of racial or ethnic cephalometric patterns to support these findings in the studied populations. In addition, a misunderstanding occurs when overlooking the different periods of growth or ages within and between the studied groups. Furthermore, there is no mention of previous orthodontic treatment. By contrast, there is a lack of information about the medically compromised health status of people with SCD, such as the life period of SCD's diagnosis; the number and timing of blood transfusions; the medical history of hospitalizations, vaso-occlusive crises, or hydroxyurea use. Conclusion: racial and ethnic concerns for the diagnosis of malocclusions and craniofacial anomalies, as well as SCD landmarks, are underappreciated in the examined dental literature. Discarding them also demonstrates institutional racism.

Introdução: a doença falciforme é uma doença hematológica, hereditária, crônica, que afeta principalmente, a população negra, em escala global. Na literatura odontológica, os achados craniofaciais e oclusais relacionados à doença falciforme são discordantes, mas, em comum, desconsideram a perspectiva racial. Objetivo: este artigo revisou criticamente a literatura odontológica e discutiu os achados encontrados na perspectiva racial/étnica. Fonte dos dados: estudos primários e secundários selecionaram 146 ocorrências de quatro bases de dados da literatura científica. Dois revisores extraíram independentemente os dados dos onze estudos incluídos. Síntese dos dados: com base na cefalometria lateral, a maioria dos estudos concluiu que as anormalidades craniofaciais e maloclusões, como protrusão maxilar, padrão esquelético de classe II, padrão de crescimento facial vertical, perfil facial convexo, retrusão mandibular e rotação posterior da mandíbula foram os mais comuns achados para pessoas com doença falciforme. No entanto, ao considerar a perspectiva étnico-racial, não há menção na maioria dos estudos de ajustes dos padrões cefalométricos específicos para as populações racializadas, nem tampouco são consideradas características do grupo populacional e da doença falciforme em si, como sua severidade, o momento de vida em que o diagnóstico ocorreu, número e período de hemotransfusões, internações, crises vaso-oclusivas ou uso de hidroxiureia. Além disso, a ampla faixa etária em diferentes períodos de crescimento ósseo e a ausência de informação sobre tratamento ortodôntico prévio foram observadas. Conclusão: há omissão sobre considerações étnico-raciais para relatar anormalidades craniofaciais e maloclusões sobre doença falciforme na literatura odontológica revisada. Isto pode ser uma expressão do racismo.

Upper airway assessment in obstructive sleep apnea patients: can computed tomography with lateral cephalometry replace drug-induced sleep endoscopy (DISE)?

OBJECTIVE: To evaluate the association between results from drug-induced sleep endoscopy (DISE) and computed tomography with lateral cephalometry (CTLC) of the pharynx in obstructive sleep apnea (OSA) patients, regarding the same anatomic level, in order to understand if CTLC could replace DISE in selected patients. STUDY DESIGN: Cross-sectional. SETTING: Tertiary hospital. METHODS: A total of 71 patients who attended the Sleep Medicine Consultation in the Otorhinolaryngology Department of Hospital CUF Tejo between 1.6.2019 and 30.9.2021, performed a polysomnographic sleep study and were elected to undergo DISE and CTLC of the pharynx for diagnostic purposes were selected. Obstructions at the same anatomic levels - tongue base, epiglottis and velum - were compared in both exams. RESULTS: Patients with reduction of epiglottis-pharynx space on CTLC had also a complete obstruction at epiglottis level on the VOTE classification of DISE (p = 0,027). Reduction of velum-pharynx space or tongue base-pharynx space were not related to complete obstruction of the velum (P = 0,623) or the tongue base (p = 0,594) found in DISE. Those with two or more space reductions had a tendency to multilevel obstruction observed in DISE (p = 0.089). CONCLUSION: When evaluating the obstruction level(s) of an OSA patient, efforts should be made to perform DISE, since CTLC measures, though regarding at the same structures, don´t correlate completely with obstructions observed in DISE.

Does Postpartum Hypopituitarism Influence the Craniofacial Pattern? A Case-Control Study with Sheehan's Syndrome Patients

This study aimed to assess the craniofacial morphologic aspects of Sheehan's syndrome (SHS) patients.An observational study was performed with 19 women diagnosed with SHS and 19 controls matched by age and sex. Lateral cephalometric radiographs were obtained, and 30 linear and angular measurements were analyzed using the Radiocef Studio 2 software. The mean age of patients was 65.47 ± 10.19 years. The main findings were propositioned maxilla (52.63 %) and mandible (52.63 %) relative to the cranial base, mandibular prognathism in 73.68 %, deep growth pattern in 42.1 %, increased mandibular plane in 36.84 %, and reduction in anterior facial height. The SHS group showed statistically significant differences in SNB (p=0.026), N-Me (p=0.006), soft palate length (p=0.011), and Ena-Me (p<0.001) in comparison with controls. The standard deviation score analysis revealed altered values in relation to total maxillary and mandibular lengths. SHS showed altered craniofacial morphology, characterized by maxillo- mandibular prognathism, brachyfacial type, increased mandibular plane, and reduction in soft palate length. This study reports novel findings in SHS.

Este estudio tuvo como objetivo evaluar los aspectos morfológicos craneofaciales de los pacientes con síndrome de Sheehan (SHS). Se realizó un estudio observacional con 19 mujeres diagnosticadas con SHS y 19 controles asociados por edad y sexo. Se obtuvieron radiografías cefalométricas laterales y se analizaron 30 medidas lineales y angulares mediante el software Radiocef Studio 2. La edad media de los pacientes fue de 65,47 ± 10,19 años. Los principales hallazgos fueron proposición maxilar (52,63 %) y mandíbula (52,63 %) con respecto a la base del cráneo, prognatismo mandibular en 73,68 %, patrón de crecimiento profundo en 42,1 %, aumento del plano mandibular en 36,84 % y reducción de la altura facial anterior. El grupo SHS mostró diferencias estadísticamente significativas en SNB (p=0,026), N-Me (p=0,006), longitud del paladar blando (p=0,011) y Ena-Me (p<0,001) en comparación con los controles. El análisis de la puntuación de la desviación estándar reveló valores alterados en relación con las longitudes maxilares y mandibulares totales. El SHS mostró una morfología craneofacial alterada, caracterizada por prognatismo maxilomandibular, tipo braquifacial, aumento del plano mandibular y reducción de la longitud del velo del paladar. Este estudio informa hallazgos novedosos en SHS.

Cephalometric Evaluation of Maxillary Incisors Torque and Vertical Changes Utilizing Standard Edgewise Mechanics

In 1995 Gebeck & Merrifield studied a successful and unsuccessful treated Class I and Class II's samples; they found a -1.33 mm intrusion in the former and a 0.80 mm extrusion in the latter. The purpose of this article was to perform a cephalometric evaluation of maxillary incisors torque and vertical changes. We studied a sample of 129 patients, 30 males and 99 females, taken from The Charles H. Tweed Foundation Long Term Study, at pretreatment mean age 12.93 years, posttreatment mean age 16.19 years and follow up post retention mean age 29.83 years, a 13.88 years interval. The records were collected from private practitioners across the North American continent who used Standard Edgewise Mechanics and were members of the Charles H. Tweed Foundation. All patients were Class I and II American whites treated with the extraction of 4 premolars. We found an Upper anterior incisal edge to PP vertical linear measurement 28.7 and 29.2 mm, +0.53 mm (p<0.019) from pretreatment to posttreatment. The average Upper 1 to SN angle was 103.2 ° at pretreatment and 100.1° at posttreatment, -3.2° (p<0.000), Upper 1 to PP 111.0° and 108.9°, -2.2° (p<0.000), the three of them statistically significant. Conversely, Upper 1 to commissure was not. The four measurements were also statistically significant posttreatment to follow up, upper anteriors kept losing torque after posttreatment, and less upper anteriors surface was below the commissure. Some torque loss and vertical extrusion can be expected while treating patients with extractions of four premolars, therefore, upper incisor inclination increase and vertical change by itself cannot determine the success of treatment.

En 1995, Gebeck y Merrifield estudiaron muestras de Clase I y Clase II tratadas con éxito y sin éxito; encontraron una intrusión de -1,33 mm en el primero y una extrusión de 0,80 mm en el segundo. El propósito de este artículo fue realizar una evaluación cefalométrica del torque y los cambios verticales de los incisivos maxilares. Estudiamos una muestra de 129 pacientes, 30 hombres y 99 mujeres, tomados del estudio a largo plazo de la Fundación Charles H. Tweed, con una edad media previa al tratamiento de 12,93 años, una edad media posterior al tratamiento de 16,19 años y una edad media de seguimiento posterior a la retención de 29,83 años, con un intervalo de de 13,88 años. Los registros se recopilaron de médicos privados en todo el continente norteamericano que utilizaron Standard Edgewise Mechanics y eran miembros de la Fundación Charles H. Tweed. Todos los pacientes eran blancos americanos Clase I y II tratados con extracción de 4 premolares. Encontramos una medida lineal vertical del borde incisal anterior superior a PP de 28,7 y 29,2 mm, +0,53 mm (p<0,019) desde el pretratamiento hasta el postratamiento. El promedio del ángulo Superior 1 a SN fue de 103,2° en el pretratamiento y 100,1° en el postratamiento, -3,2° (p<0,000), Superior 1 a PP 111,0° y 108,9°, -2,2° (p<0,000), los tres estadísticamente significante. Por el contrario, Superior 1 a la comisura no lo era. Las cuatro mediciones también fueron estadísticamente significativas para el seguimiento después del tratamiento, los dientes anteriores superiores siguieron perdiendo torsión después del tratamiento y se observó menor superficie de los dientes anteriores superiores debajo de la comisura. Se puede esperar cierta pérdida de torque y extrusión vertical al tratar a pacientes con extracciones de cuatro premolares, por lo tanto, el aumento de la inclinación del incisivo superior y el cambio vertical por sí mismos no pueden determinar el éxito del tratamiento.

Caracterización epidemiológica, clínica y cefalométrica del brote anormal de los terceros molares / Epidemiological, clinical and cephalometric characterization of the abnormal eruption of third molars

Introducción: El brote de los terceros molares es un proceso que no está del todo explicado, pero durante su erupción puede provocar diferentes accidentes o complicaciones. Objetivo: Caracterizar el brote anormal de los terceros molares según variables epidemiológicas, clínicas y cefalométricas. Método: Se realizó un estudio observacional, descriptivo y transversal en la Clínica Estomatológica Provincial Docente «Mártires del Moncada», de Santiago de Cuba, desde noviembre de 2019 a febrero de 2020. La población estuvo conformada por jóvenes de 18 a 25 años de edad; la muestra fue seleccionada por muestreo aleatorio simple. Se tuvieron en cuenta las siguientes variables: sexo, color de la piel, brote anormal y otras variables cefalométricas. Resultados: De los 84 dientes incluidos en el estudio, se detectaron 66 terceros molares con brote anormal (78,6 %). El promedio asociado al brote de estos molares de espacio óseo superior insuficiente fue igual para los superiores con medias de 25,9 mm; el de angulación inadecuada resultó obtuso en el superior izquierdo con 128,3º y agudo en los inferiores derechos con 58,8º; asimismo el mayor diámetro mesiodistal inadecuado fue el de los inferiores derechos con 15,7 mm. Conclusiones: El brote anormal de los terceros molares se caracteriza por afectar, de forma importante, a féminas y a individuos mestizos. Su observación se singulariza, fundamentalmente, en molares inferiores con espacios óseos posteriores reducidos, mesioangulaciones y diámetros mesiodistales considerables.

Introduction: eruption of the third molars is a process that is not fully explained in the literature; however it is known that their eruption can cause different complications. Objective: to characterize the abnormal eruption of third molars according to epidemiological, clinical and cephalometric variables. Methods: an observational, descriptive and cross-sectional study was carried out at "Mártires del Moncada" Provincial Teaching Dental Clinic, in Santiago de Cuba, from November 2019 to February 2020. The population consisted of young people aged 18-25 years; the sample was selected by simple random sampling. Gender, skin color, abnormal eruption and other cephalometric variables were taken into account. Results: sixty-six third molars with abnormal eruption were detected from the 84 teeth included in the study (78.6%). The average associated with the eruption of these molars with insufficient upper bone space was the same for the upper ones with means of 25.9 mm; the average with inadequate angulation was obtuse in the upper left third molar with 128.3º and the acute one in the lower right third molars with 58.8º; the lower right third molars likewise had the largest inadequate mesiodistal diameter with 15.7 mm. Conclusions: the abnormal eruption of third molars is characterized by significantly affecting females and mixed-race individuals. Its observation is singled out, fundamentally, in lower molars with reduced posterior bone spaces, mesioangulations and considerable mesiodistal diameters.

Volumetric Evaluation of the Upper Airways in Relation to the Gonial Angle / Avaliação Volumétrica das Vias Aéreas Superiores com Relação ao Ângulo Goníaco

The upper airspace is essential to understand the physiology and pathogenesis of its obstruction, complementary exams based on images have been used to evaluate the upper airspace. The objective of this study was to evaluate, by means of computed tomography, the upper airways (UAS), in relation to anatomical variables, emphasizing the gonial angle and comparing it with volume in mm³, sex and age. A total of 124 computed tomography scans were analyzed using DICOM files (digital image communication in medicine) made available by a radiology clinic using the ITK-snap program (version 3.6.0), upper airway volumes, sex, age and gonial angle values on both the right and left sides were tabulated in a table in the Excel 2010 program of the Microsoft Office 2010 package, and subsequently analyzed in the SPSS software with statistical analysis using the Levene Test and also the ANOVA test, to obtain of the results. The values found for the gonial angle did not indicate a significant difference. However, the present work confirms that within each of these groups there is a homogeneity of variances, corroborating the results reported in the literature. However, regarding the volume of the upper airways, we found that in men and in individuals aged over 34 years, the volume is greater.(AU)

O espaço aéreo superior é essencial para compreender a fisiologia e a patogênese de sua obstrução, exames complementares baseados em imagens têm sido empregados para avaliar o espaço aéreo superior. O objetivo desse estudo foi avaliar por meio de tomografia computadorizada, as vias aéreas superiores (VAS), com relação a variáveis anatômicas, dando ênfase ao ângulo goníaco e comparando com volume em mm³, sexo e idade. Foram analisados 124 exames de tomográfica computadorizada, por meio dos arquivos DICOM (comunicação de imagens digitais em medicina) disponibilizados por uma clínica radiológica, através do programa ITK-snap (versão 3.6.0), os volumes das vias aéreas superiores, o sexo, a idade e os valores do ângulo goníaco tanto do lado direito como do lado esquerdo foram tabulados em tabela no programa Excel 2010 do pacote Microsoft Office 2010, e analisados posteriormente no software SPSS com análise estatística pelo Teste de Levene e também teste ANOVA, para obtenção dos resultados. Os valores encontrados para o ângulo goníaco não indicaram diferença significativa. Contudo, o presente trabalho confirma que dentro de cada um desses grupos há uma homogeneidade das variâncias e corroborando com os resultados relatados na literatura. No entanto com relação ao volume das vias aéreas superiores encontramos que em homens e em indivíduos com idade superior a 34 anos o volume é superior.(AU)

Reproducibility of linear and angular cephalometric measurements obtained by an artificial-intelligence assisted software (WebCeph) in comparison with digital software (AutoCEPH) and manual tracing method

ABSTRACT Introduction: It has been suggested that human errors during manual tracing of linear/angular cephalometric parameters can be eliminated by using computer-aided analysis. The landmarks, however, are located manually and the computer system completes the analysis. With the advent of Artificial Intelligence in the field of Dentistry, automatic location of the landmarks has become a promising tool in digital Orthodontics. Methods: Fifty pretreatment lateral cephalograms obtained from the Orthodontic department of SRM dental college (India) were used. Analysis were done by the same investigator using the following methods: WebCeph™, AutoCEPH© for Windows or manual tracing. Landmark identification was carried out automatically by Artificial Intelligence in WebCeph™ and with a mouse driven cursor in AutoCEPH©, and manually using acetate sheet and 0.3-mm pencil, ruler and a protractor. The mean differences of the cephalometric parameters obtained between the three methods were calculated using ANOVA with statistical significance set at p<0.05. Intraclass correlation coefficient (ICC) was used to determine both reproducibility and agreement between linear and angular measurements obtained from the three methods and intrarater reliability of repeated measurements. ICC value of >0.75 indicated good agreement. Results: Intraclass correlation coefficient between the three groups was >0.830, showing good level of agreement, and the value within each group was >0.950, indicating high intrarater reliability. Conclusion: Artificial Intelligence assisted software showed good agreement with AutoCEPH© and manual tracing for all the cephalometric measurements.

RESUMO Introdução: Tem sido sugerido que os erros humanos durante o traçado manual das medidas cefalométricas lineares/angulares podem ser eliminados usando a análise guiada por computador. Os pontos de referência, no entanto, são localizados manualmente e o sistema computadorizado completa a análise. Com o advento da Inteligência Artificial na Odontologia, a localização automática dos pontos de referência tornou-se uma ferramenta promissora na Ortodontia digital. Métodos: Cinquenta cefalogramas laterais pré-tratamento obtidos do departamento de Ortodontia da Faculdade de Odontologia SRM (Índia) foram usados. Todas as análises foram feitas pelo mesmo investigador, usando os seguintes métodos: WebCeph™, AutoCEPH© para Windows ou traçado manual. A identificação dos pontos foi realizada automaticamente por Inteligência Artificial no WebCeph™; com o cursor do mouse, no AutoCEPH©; e manualmente, utilizando folha de acetato e lápis 0,3 mm, régua e transferidor. As diferenças médias dos parâmetros cefalométricos entre os três métodos foram calculadas por ANOVA com significância estatística fixada em p<0,05. O coeficiente de correlação intraclasse (ICC) foi usado para determinar a reprodutibilidade e a concordância entre as medidas lineares e angulares obtidas pelos três métodos e a confiabilidade intraexaminador para medidas repetidas. O valor de ICC > 0,75 indicou boa concordância. Resultados: O ICC entre os três grupos foi >0,830, mostrando bom nível de concordância, e o valor dentro de cada grupo foi >0,950, indicando alta confiabilidade intra-avaliador. Conclusão: O software assistido por Inteligência Artificial mostrou boa concordância com o AutoCEPH© e o traçado manual para todas as medidas cefalométricas.

Study of the cephalometric standards of individuals with normal occlusion and prevalence of the malocclusion in the city of Rio de Janeiro, Rio de Janeiro, Brazil / Estudo dos padrões cefalométricos de indivíduos com oclusão normal e prevalência das maloclusões no município do Rio de Janeiro

ABSTRACT Objective: The accomplishment of this cephalometric objective to evaluate the face characteristics of this cefalometric work individuals had to the city of this cephalometric prevalence, as well as measure the objective of malocclusion. Methods: For this study, 531 sort of individuals of the masculine organizations of Rio de Janeiro had been submitted to the clinical chait of the course of Master in Orthodontics of the Center Research Leopold Mandic, of which if it got prevalence of malocclusion. Results: Of this sample, it was observed that 22 individuals with normal occlusion and that if they had never submitted the orthodontic treatment. In these patients they had been made taken from normal head in lateral cephalometric radiographs and evaluated the cephalometrics largeness: SNA, SNB, ANB, Axle "Y", NS.Go-Me, FMA, FMIA, IMPA, 1.NA, 1- NA, 1.NB, 1-NB, 1.1, 1.SN, 1.Go-Gn, SN.PLO, AO-BO, Line H, Z angle, P-NB, AFA, AFP and IAF. The gotten date had been submitted to the analysis with a level of significance of 5% (p< 0.05) and used descriptive statistics and the error of Dalbergh. The results showed that of the total of the evaluated sample, the malocclusion of 44.3% of Classroom I; 29.5% of Classroom II; 17.2% of Classroom III and 9.2% of normal occlusion. Conclusion: The individuals with normal occlusion of the city of Rio De Janeiro had presented equal cephalometric characteristics with many standard measures described in literature, except for the superior incisor that were presented vestibulate and the well inclined inferior incisor for vestibular contest.

RESUMO Objetivos: A realização deste trabalho teve como objetivo avaliar cefalometricamente as características faciais de indivíduos pertencentes ao município do Rio de Janeiro-RJ, bem como mensurar a prevalência de maloclusão. Métodos: Para este estudo, 531 indivíduos do gênero masculino pertencentes às organizações militares do Rio de Janeiro foram submetidos à ficha clínica do curso de Mestrado em Ortodontia da Faculdade São Leopoldo Mandic, dos quais se obteve a prevalência de maloclusão. Resultados: Dessa amostra, observou-se que 22 indivíduos possuíam oclusão normal e que nunca haviam se submetido a tratamento ortodôntico. Nesses pacientes foram feitas tomadas de telerradiografias de cabeça em norma lateral e avaliadas as grandezas cefalométricas: SNA, SNB, ANB, Eixo "Y", NS.Go-Me, FMA, FMIA, IMPA, 1.NA, 1-NA, 1.NB,1-NB, 1.1, 1.SN, 1.Go-Gn, SN.PLO, AO-BO, Linha H, ângulo Z, P-NB, AFA, AFP e IAF. Os dados obtidos foram submetidos à análise com nível de significância de 5% (p< 0,05) e utilizadas estatísticas descritivas e o erro de Dalbergh. Os resultados mostraram que do total da amostra avaliada, a maloclusão foi de 44,3% de Classe I; 29,5% de Classe II; 17,2% de Classe III e 9,2% de oclusão normal. Conclusão: Os indivíduos com oclusão normal do município do Rio de Janeiro apresentaram características cefalométricas condizentes com muitas medidas padrões descritas na literatura, exceto para o incisivo superior que apresentou-se vestibularizado e o incisivo inferior bem inclinado para vestibular.

Estado del arte de inteligencia artificial en ortodoncia. Revisión narrativa / State of the art on artificial intelligence in orthodontics. A narrative review

Introducción: Inteligencia artificial (IA) es la automatización de actividades vinculadas con procesos de pensamiento humano. En ortodoncia se han desarrollado sistemas que asistidos por IA pueden tomar decisiones terapéuticas y realizar análisis. No existe un compendio actualizado sobre el uso de IA en ortodoncia. Objetivos: Describir los usos de IA en ortodoncia de acuerdo con la literatura actual. Metodología: Se realizó una revisión narrativa en las bases Medline y SciELO mediante la búsqueda: (orthodont*) AND (“machine learning” OR “deep learning” OR “artificial intelligence” OR “neural network”). Resultados: Se obtuvieron 19 artículos que mostraron que IA se ha desarrollado en cinco áreas: 1) Cefalometría asistida por IA, donde la localización de puntos y análisis cefalométricos mostraron una precisión igual a ortodoncistas. 2) Localización de dientes no erupcionados en CBCT, con resultados similares entre IA y ortodoncistas. 3) Determinación de edad y maduración ósea de forma más eficiente apoyada por IA, que por métodos convencionales, 4) Análisis facial, donde la IA permite una evaluación objetiva del atractivo facial, con aplicaciones en diagnóstico y planificación quirúrgica. 5) Decisiones terapéuticas con IA, para determinar la necesidad de exodoncias y dientes que serán extraídos. Discusión: La IA se está incorporando aceleradamente en ortodoncia, por lo que debe conocerse conceptos y posibilidades que brinda. (AU)Conclusiones:Un número creciente de artículos sobre usos de IA en ortodoncia muestran resultados similares con IA a los obtenidos por especialistas. Sin embargo, la evidencia aún es poca y principalmente experimental, por lo que la IA debiera usarse cautelosamente en ortodoncia.

Introduction: Artificial Intelligence (AI) is the automation of activities related to human thought processes. In orthodontics, systems have been developed which, assisted by AI, can make therapeutic decisions and perform analyses. There is no updated compendium on the use of AI in orthodontics. Objectives: To describe the uses of AI in orthodontics according to the current literature. Methodology: A narrative review was performed in the Medline and SciELO bases by means of the following search: (orthodont*) AND (“machine learning” OR “deep learning” OR “artificial intelligence” OR “neural network”). Results: 19 articles were obtained, showing that AI has been developed in four areas: 1) IA assisted cephalometry, where localization of cephalometric points and cephalometric analysis showed equal accuracy than orthodontists. 2) Unerupted tooth localization with CBCT, with similar results between AI and orthodontists. 3) Determination of skeletal age, which is more efficient with AI than with conventional methods. 4) Facial analysis, where AI allows an objective evaluation of facial attractiveness with applications in diagnosis and surgical planning. 5) Therapeutic decisions with AI, to determine the need for exodontia and teeth to be extracted. Discussion: AI is being incorporated rapidly in orthodontics, so we must know concepts and possibilities that it gives us in orthodontics. Conclusions: An increasing number of articles refer to the uses of AI in orthodontics, with similar results to those obtained by specialists. However, the evidence is still scarce and mainly experimental, so AI should still be used with caution in orthodontics. (AU)

Relación del crecimiento sagital de los maxilares y el índice de maduración cervical / Relationship between the sagittal growth of the maxillary and the cervical maturation index

Resumen El crecimiento del maxilar se manifiesta de manera diferente respecto a la mandíbula, la cual se caracteriza por un desarrollo sagital más tardío. El objetivo de esta investigación fue asociar el crecimiento sagital del maxilar superior e inferior con el índice de maduración cervical en radiografías cefálicas laterales de pacientes entre 8 a 20 años de la ciudad de Cuenca, Ecuador. Se realizó una investigación con enfoque cuantitativo de tipo descriptivo, correlacional y de corte transversal retrospectivo, con una base de datos de 10.586 radiografías cefálicas laterales. Se observó que el pico de crecimiento inicia alrededor de los 9 años en las mujeres y en los hombres a los 11 años, y este culmina a los 13 años en el sexo femenino y entre los 14 y 17 años en el sexo masculino. Además, se determinó una correlación baja ente el crecimiento sagital del maxilar superior y los estadios de maduración vertebral (r=0,338) así como con el maxilar inferior (r= 0,357). Finalmente, se concluyó que el crecimiento del maxilar superior se produce en los primeros estadios de maduración cervical, mientras que en el maxilar inferior el crecimiento longitudinal se produce a partir del estadio III de maduración cervical.

Abstract The growth of the maxilla manifests itself differently from the mandible, which is characterized by a later sagittal development. The objective of the research was to associate the sagittal growth of the upper and lower jaw and the cervical maturation index in lateral cephalic radiographs of patients between 8 and 20 years of age from the city of Cuenca. A descriptive, correlational and retrospective cross-sectional quantitative approach was conducted with a database of 10,586 lateral cephalic radiographs. It was observed that the peak of growth begins around 9 years of age in women and at 11 years in men, and culminates at age 13 in females, and between 14 and 17 years in males. In addition, a low correlation was determined between the sagittal growth of the upper jaw and the stages of vertebral maturation (r = 0.338) as well as with the lower jaw (r = 0.357). Finally, it was concluded that the growth of the upper jaw occurs in the first stages of cervical maturation, while in the lower jaw, longitudinal growth occurs from stage III of cervical maturation.

Mandibular angle morphology in open bite subjects according to the skeletal relationship: a cbct short report / Morfología del ángulo mandibular en sujetos con mordida abierta de acuerdo a la relación esquelética: un informe breve en cbct

Aim: The purpose of this research was to three-dimensionally evaluate the mandibular angle morphology in open bite subjects with different sagittal skeletal relationships. Material and Methods: Cone beam computed tomography (CBCT) images of 26 subjects (12 men and 14 women) with anterior open bite were evaluated. The sample included 3 groups categorized by their sagittal skeletal relationship (based on ANB angle and anteroposterior dysplasia indicator (APDI)): Class I (n=9), Class II (n=6) and Class III (n=11). The total gonial angle, upper gonial angle, lower gonial angle, intergonial width, interantegonial width and antegonial notch depth were measured. ANOVA and Tukey tests were used for intergroup comparison. The Kruskal Wallis test was also used when necessary. In addition, the Pearson correlation coefficient was calculated to evaluate significant correlations between overbite and antegonial notch depth with gonial angle, Frankfurt mandibular plane angle (FMA) and the palatal plane-mandibular plane (PP-MP). Results: A significant difference was only found on the upper gonial angle between Class II and Class III (p=0.047). The upper gonial angle showed greater values (48°±3°) with the mandibular branch toward backward in Class III subjects and lower values (42.42°±4.39°) with the mandibular ramus leaning forward in subjects with Class II skeletal relationship. Besides, only a statistically significant correlation was found between overbite and the lower gonial angle (r=-0.418, p=0.034). Conclusion: Mandibular angle morphology is similar in anterior open bite subjects with different sagittal skeletal relationships, except for the upper gonial angle which is increased in Class III and decreased in Class II subjects with open bite. Lower gonial angle is negatively correlated with overbite. This difference should be considered by orthodontists when planning their treatments.

Objetivo: El propósito de esta investigación fue evaluar tridimensionalmente la morfología del ángulo mandibular en sujetos de mordida abierta con diferentes relaciones esqueléticas sagitales. Material y Métodos: Se evaluaron imágenes de tomografía computarizada de haz cónico (CBCT) de 26 sujetos (12 hombres y 14 mujeres) con mordida abierta anterior. La muestra incluyó 3 grupos categorizados por su relación esquelética sagital (según el ángulo ANB y el indicador de displasia anteroposterior (APDI)): Clase I (n=9), Clase II (n=6) y Clase III (n=11). Se midieron el ángulo goniaco total, el ángulo goniaco superior, el ángulo goniaco inferior, el ancho intergonial, el ancho interantegonial y la profundidad de la entalladura antegonial. Se utilizaron las pruebas ANOVA y Tukey para la comparación intergrupal. La prueba de Kruskal Wallis también se utilizó cuando fue necesario. Además, se calculó el coeficiente de correlación de Pearson para evaluar correlaciones significativas entre la sobremordida y la profundidad de la entalladura antegonial con el ángulo goniaco, el ángulo del plano mandibular de Frankfurt (FMA) y el plano palatino-plano mandibular (PP-MP). Resultados: Solo se encontró una diferencia significativa en el ángulo goniaco superior entre la Clase II y la Clase III (p=0.047). El ángulo gonial superior mostró valores mayores (48°±3°) con la rama mandibular hacia atrás en sujetos Clase III y valores más bajos (42,42°±4,39°) con la rama mandibular inclinada hacia adelante en sujetos con Clase II esquelética relación. Además, solo se encontró una correlación estadísticamente significativa entre la sobremordida y el ángulo goniaco inferior (r= -0,418, p= 0,034). Conclusión: La morfología del ángulo mandibular es similar en sujetos con mordida abierta anterior con diferentes relaciones esqueléticas sagitales, excepto por el ángulo goniaco superior que aumenta en la Clase III y disminuye en sujetos de Clase II con mordida abierta. El ángulo gonial inferior se correlaciona negativamente con la sobremordida. Los ortodoncistas deben considerar esta diferencia al planificar sus tratamientos.

Association between the intensity of obstructive sleep apnea and skeletal alterations in the face and hyoid bone / Relação entre a influência da gravidade da apneia obstrutiva do sono e alterações craniofaciais e do posicionamento do osso hioide

Abstract Introduction The association between the intensity of obstructive sleep apnea and skeletal alterations in the face and hyoid bone is still scarcely addressed in the literature. Objective To evaluate whether the intensity of obstructive sleep apnea is associated with craniofacial alterations and the position of the hyoid bone in children with mixed dentition. Methods 76 children aged 7 to 10 years old were examined by otorhinolaryngological evaluation, polysomnography, and orthodontic assessment, including cephalometry. The participants were divided in 3 groups: primary snoring, mild obstructive sleep apnea and moderate to severe obstructive sleep apnea. Cephalometric measures of the face and hyoid bone were assessed. These measures were compared among the different groups by unpaired Student's t test. Moreover, these measures were correlated with the patient's obstructive apnea and hypopnea index variable using Pearson's correlation test. Results Of the 76 children, 14 belonged to group 1, with primary snoring; 46 to group 2, with mild obstructive sleep apnea; and 16 to group 3, with moderate-severe obstructive sleep apnea. There was no difference between the groups regarding the craniofacial variables. Children with obstructive sleep apnea showed a longer distance from the hyoid bone to the mandibular plane when compared to the primary snoring group (p < 0.05). Between the two obstructive sleep apnea subgroups, patients with moderate or severe disease showed significantly shorter horizontal distance between the hyoid bone and the posterior pharyngeal wall (p < 0.05), when compared to the groups with mild obstructive sleep apnea. We also observed a significant positive correlation between obstructive apnea and hypopnea index and the distance from the hyoid to the mandibular plane (p < 0.05) as well as a significant negative association between obstructive apnea and hypopnea index and the horizontal distance from the hyoid to the posterior pharyngeal wall (p < 0.01). Conclusion We did not observe any association between obstructive sleep apnea and linear lateral alterations of the face. In contrast, there is a direct association between obstructive sleep apnea severity and the inferior and posterior position of the hyoid bone in children aged 7 to 10 years old.

Resumo Introdução A relação entre a intensidade da apneia obstrutiva do sono e alterações esqueléticas da face e do hioide em crianças é pouco explorada na literatura. Objetivo Avaliar se a intensidade da apneia obstrutiva do sono correlaciona-se às alterações craniofaciais e ao posicionamento do osso hioide em crianças em fase de dentição mista. Método Foram submetidas 76 crianças entre 7 e 10 anos à avaliação otorrinolaringológica, polissonografia e avaliação ortodôntica, inclusive cefalometria. Os participantes foram divididos em 3 grupos: grupo 1 com ronco primário, grupo 2 com apneia obstrutiva do sono leve e grupo 3 com apneia obstrutiva do sono moderada/grave. Foram analisadas medidas cefalométricas da face e do osso hioide. Essas medidas foram comparadas entre si dentro dos diferentes grupos por teste t de Student não pareado. Além disso, essas medidas foram correlacionadas com a variável índice de apneias obstrutivas e hipopneias do paciente através do teste de correlação de Pearson. Resultados Das 76 crianças, 14 constituíram o grupo 1, ronco primário; 46 o grupo 2, apneia obstrutiva do sono leve; e 16 o grupo 3, apneia obstrutiva do sono moderada/grave. Não se observou diferença significante entre os grupos para as variáveis craniofaciais. Observou-se maior distância do osso hioide ao plano mandibular nos dois grupos com apneia obstrutiva do sono quando comparado ao ronco primário (p < 0,05). Entre os dois subgrupos da apneia obstrutiva do sono, os pacientes com doença moderada ou grave apresentaram distância horizontal entre o hioide e a parede posterior da faringe significantemente menor (p < 0,05), quando comparados aos grupos com apneia obstrutiva do sono leve. Observamos ainda correlação significantemente positiva entre índice de apneias obstrutivas e hipopneias e a distância do hioide ao plano mandibular (p < 0,05) e significantemente negativa entre índice de apneias obstrutivas e hipopneias e distância horizontal do hioide com a parede posterior da faringe (p < 0,01). Conclusão Não observamos relação da apneia obstrutiva do sono com alterações lineares laterais da face. Em contraste, existe relação direta entre a gravidade da apneia obstrutiva do sono e a posição inferior e posterior do osso hioide em crianças entre 7 e 10 anos.

Avaliação da acurácia nas mensurações lineares craniofaciais por meio do programa Horos / Assessment of the accuracy of craniofacial linear measurements on Horos software

Introdução: Na antropometria craniofacial avaliam-se quantitativamente as estruturas anatômicas faciais, e as tomografias computadorizadas de feixe cônico (TCFC) têm contribuído significativamente para refinar essa abordagem. A análise antropológica e morfológica do crânio para estimativa de idade, ou a avaliação das espessuras de tecidos moles faciais para aproximação facial forense, podem ser beneficiadas com o avanço das ferramentas de reconstrução e visualização de imagens de TCFC em softwares open source como o HorosTM. Objetivo: Avaliar a confiabilidade e a precisão de medidas lineares realizadas em TCFC em Reconstrução Multiplanar (MPR), no modo de visualização de MIP, nas espessuras de corte mínima (Emín) e máxima (Emáx). Material e método: Foram selecionados 17 crânios pertencentes ao biobanco do Laboratório de Antropologia e Odontologia Forense da Universidade de São Paulo (OFLab-FOUSP) para a mensuração de 10 grandezas lineares, aferidas de três maneiras distintas: uma diretamente sobre o crânio (padrão-ouro) e duas no software (em Emín e Emáx). Para a análise estatística foi adotado o nível de significância de 5%. Resultados: O CCI (Coeficiente de Concordância Intra-classe) inter e intra-examinadores foi excelente. A consistência das medidas entre os métodos, nos grupos A (crânio-Emín) e B (crânio-Emáx) foi verificada pela análise de Bland-Altman. O grupo B apresentou maior precisão de medidas, porém, a diferença menor do que 1 mm encontrada no grupo A não compromete a análise craniométrica. Conclusão: Ambos os métodos são confiáveis para mensurações lineares

Introduction: In craniofacial anthropometry, facial anatomical structures are quantitatively evaluated, and cone beam computed tomography (CBCT) has significantly contributed to refine this approach. Anthropological and morphological analysis of the skull for age estimation or, assessment of facial soft tissue thickness for forensic facial approximation, can be benefited by advancement of CBCT image reconstruction and visualization tools at open-source software such as HorosTM. Objective: This study verified the reliability and accuracy of linear measurements performed in CBCT in Multiplanar Reconstruction (MPR), in MIP visualization mode, at minimum (STmin) and maximum (STmax) slab thicknesses. Material and Method: 17 skulls from biobank of the Laboratory of Forensic Anthropology and Dentistry of University of São Paulo (OFLab-FOUSP) were selected for measurement of 10 linear distances, measured in three different ways, one directly on the skull (gold standard) and two in software (in STmin and STmax). For statistical analysis, the significance level of 5% was adopted. Results: Inter- and intra-examiner ICC (Intraclass Correlation Coefficient) was excellent. The consistency of measurements between the methods in groups A (skull-STmin) and B (skull-STmax) was verified by Bland-Altman analysis. Group B showed greater measurement accuracy than group A. However, differences found in group A was smaller than 1 mm, and it does not compromise the craniometric analysis. Conclusion: Both methods are reliable for linear measurements

Avaliação do crescimento fetal de crianças por meio da razão peso/perímetro cefálico / Weight/head circumference ratio at birth for assessing fetal growth

Resumo O objetivo deste artigo é utilizar a razão peso/perímetro cefálico ao nascimento para avaliar o crescimento fetal. Estudo transversal aninhado a uma coorte de nascimentos do estado da Paraíba, Nordeste do Brasil, com 726 crianças nascidas a termo e com peso maior ou igual a 2.500 gramas. As medidas antropométricas da criança, características sociodemográficas, cuidados na gestação e tipo de parto foram coletados nas primeiras 24 horas pós-parto. As crianças foram classificadas em proporcionais (peso/perímetro cefálico ≥ 0,87) e desproporcionais (peso/perímetro cefálico < 0,87). Recém-nascidos de menor idade gestacional, com peso ao nascer inferior, do sexo feminino, de famílias não beneficiárias do Programa Bolsa Família, de mães não suplementadas com ácido fólico durante a gravidez e nascidos por cesariana apresentaram menores médias da razão peso/perímetro cefálico. As médias de peso, comprimento e perímetro cefálico foram menores entre as crianças classificadas com desproporção peso/perímetro cefálico, ajustadas pelo sexo da criança. A razão peso/perímetro cefálico é um indicador útil na avaliação do crescimento fetal.

Abstract The scope of this article was to use the weight/head circumference ratio at birth to assess fetal growth. A cross-sectional study was conducted in a birth cohort in the State of Paraíba, Northeast of Brazil, with 726 children born at term and weighing 2,500 grams or more. The anthropometric measurements, sociodemographic characteristics, gestational care and type of delivery were collected in the first 24 hours after birth of infants were assessed. Infants were classified as proportionate (weight/head circumference ratio ≥0.87) versus disproportionate (<0.87). Lower mean weight/head circumference ratio was identified in newborns of lower gestational age, with lower birth weight, female, from families not benefiting from the Bolsa Família Program, of mothers who did not take folic acid during pregnancy and were born by cesarean section. Mean weight, length, and head circumference were lower among infants with disproportionate weight/head circumference ratio, independently of sex. Weight/head circumference ratio is an important indicator of fetal growth.

Longitud del maxilar superior en relación con el biotipo facial en individuos de Cuenca, Ecuador

RESUMEN Introducción: El crecimiento y desarrollo craneofacial pueden ser evaluados mediante las radiografías cefálicas laterales, con el fin de brindar un buen diagnóstico y un plan de tratamiento efectivo. Objetivo: Identificar la relación entre la longitud del maxilar superior y el biotipo facial en individuos de 18 a 45 años de la ciudad de Cuenca, Ecuador, durante el año 2019. Método: Se realizó un estudio cuantitativo, descriptivo y relacional, la muestra fue de 160 radiografías cefálicas laterales obtenidas en un centro radiológico dental maxilofacial de la ciudad de Cuenca. Se utilizó el software AutoCAD para el trazado cefalométrico. Para el análisis estadístico se usó la prueba de Kruskal-Wallis y la prueba post hoc de Tukey con un nivel de confiabilidad del 95 % (p<0,05). Se utilizó el coeficiente de correlación Rho de Spearman para determinar la relación entre la longitud maxilar (mm) y la medición esqueletal. Resultados: Se encontró que la longitud del maxilar superior de acuerdo al biotipo facial es menor en el alto y aumenta en el bajo; el biotipo facial alto presentó la menor longitud maxilar (52,18 ±4,20 mm) y el promedio más alto fue el medio-bajo (54,37 ±4,15 mm). En el sexo masculino el promedio más alto se observó en el biotipo bajo (55,38 ±4,55 mm) y el menor valor fue en el biotipo medio alto (53,10 ±3,23 mm), en el sexo femenino el promedio más alto se encontró en el biotipo facial medio bajo (53,84 ±4,01 mm) y el promedio más bajo fue en el biotipo alto (51,64 ±3,68 mm). Conclusiones: En la medida que el biotipo facial aumenta la longitud del maxilar disminuye. No existe una relación significativa entre la longitud maxilar y edad y entre la longitud y sexo.

ABSTRACT Introduction: Craniofacial growth and development can be evaluated through lateral head radiographs, in order to provide a good diagnosis and an effective treatment plan. Objective: To identify the relationship between the length of the upper jaw and the facial biotype in individuals aged 18 to 45 years in the city of Cuenca, Ecuador, during the year 2019. Method: A quantitative, descriptive and relational study was carried out; the sample was of 160 lateral head radiographs obtained in a maxillofacial dental radiology center in the city of Cuenca. AutoCAD software was used for the cephalometric tracing. For statistical analysis, the Kruskal-Wallis test and Tukey's post hoc test were used with a reliability level of 95% (p<0.05). Spearman's Rho correlation coefficient was used to determine the relationship between maxillary length (mm) and skeletal measurement. Results: It was found that the length of the upper jaw according to facial biotype is shorter in the upper jaw and increases in the lower; the tall facial biotype presented the shortest maxillary length (52.18±4.20 mm) and the highest average was the medium-low (54.37±4.15 mm). In males, the highest average was observed in the low biotype (55.38±4.55 mm) and the lowest value was in the medium high biotype (53.10±3.23 mm); in females, the highest average was found in the medium-low facial biotype (53.84±4.01 mm) and the lowest average was in the high biotype (51.64±3.68 mm). Conclusions: As the facial biotype increases, the length of the maxillary decreases. There is no significant relationship between maxillary length and age, or between length and sex.

RESUMO Introdução: O crescimento e desenvolvimento craniofacial podem ser avaliados por meio de radiografias laterais da cabeça, a fim de fornecer um bom diagnóstico e um plano de tratamento eficaz. Objetivo: Identificar a relação entre o comprimento do maxilar superior e o biótipo facial em indivíduos de 18 a 45 anos na cidade de Cuenca, Equador, durante o ano de 2019. Método: Foi realizado um estudo quantitativo, descritivo e relacional, a amostra foi de 160 radiografias cefálicas laterais obtidas em um centro de radiologia. O software AutoCAD foi utilizado para o traçado cefalométrico. Para análise estatística, foram utilizados o teste de Kruskal-Wallis e o teste post hoc de Tukey com nível de confiabilidade de 95% (p<0,05). O coeficiente de correlação de Rho Spearman foi utilizado para determinar a relação entre o comprimento maxilar (mm) e a medida esquelética. Resultados: Verificou-se que o comprimento do maxilar superior de acordo com o biótipo facial é menor nos altos e aumenta nos baixos ; o biótipo facial alto apresentou o menor comprimento maxilar (52,18 ± 4,20 mm) e a maior média foi o médio-baixo (54,37 ± 4,15 mm). No sexo masculino, a maior média foi observada no biótipo baixo (55,38 ± 4,55 mm) e o menor valor foi no biótipo médio alto (53,10 ± 3,23 mm), no sexo feminino a maior média foi encontrada no biótipo médio. - biótipo facial baixo (53,84 ± 4,01 mm) e a menor média foi no biótipo alto (51,64 ± 3,68 mm). Conclusões: À medida que o biótipo facial aumenta, o comprimento da maxila diminui. Não há relação significativa entre comprimento maxilar e idade e entre comprimento e sexo.