Frecuencia de Ponticulus posticus en Telerradiografías Laterales de Cráneo / Frequency of Ponticulus posticus in Digital Lateral Cephalograms

En el arco posterior del atlas se describe una variación de tejido óseo denominada Ponticulus posticus (PP), la cual se ha relacionado con el desarrollo de dolor cervical. El objetivo de este estudio fue determinar la frecuencia de PP en telerradiografías laterales digitales. Este estudio correspondió a un estudio observacional descriptivo, donde se analizaron 450 telerradiografías laterales digitales obtenidas de la base de datos del Servicio de Imagenología Oral y Maxilofacial de la Facultad de Odontología de la Universidad Andrés Bello, Viña del Mar, Chile. Se analizó la presencia de PP en cada cefalograma, y se utilizó la clasificación de Cederberg y Stubbs para determinar los grados de osificación. Se aplicó la prueba de Chi-cuadrado para establecer una asociación entre la presencia de PP con el sexo y la edad. De las 450 telerradiografías laterales el 42,4 % presenta PP, con una mayor prevalencia entre el rango de 21-40 años. En cuanto al grado de osificación, el grado 2 fue el tipo más prevalente (25 %), seguido del grado 4 (9,5 %), el grado 3 (8 %). No se encontró asociación entre la presencia de PP con edad y género (P > 0,05). La PP es frecuente en la población y se observa a diferentes edades sin predilección por sexo.

SUMMARY: A bony tissue variation called Ponticulus posticus (PP) is described in the posterior arch of the atlas, which has been associated with the development of cervical pain. The aim of this study was to determine the frequency of PP in digital lateral cephalograms. This study was an observational descriptive study, in which 450 digital lateral cephalograms obtained from the database of the Oral and Maxillofacial Imaging Service of the Faculty of Dentistry of the Andrés Bello University, Viña del Mar, Chile, were analyzed. The presence of PP was analyzed in each cephalogram, and the Cederberg and Stubbs classification was used to determine the degrees of ossification. The Chi-square test was applied to establish an association between the presence of PP with gender and age. Of the 450 lateral cephalograms, 42.4 % presented PP, with a higher prevalence in the 21-40 year range. In terms of the degree of ossification, grade 2 was the most prevalent type (25 %), followed by grade 4 (9.5 %), and grade 3 (8 %). No association was found between the presence of PP with age and gender (P > 0.05). PP is common in the population and is observed at different ages without a sex preference.

Estudo radiográfico da inter-relação dos guias condiliana e anterior em pacientes com oclusão fisiológica / Radiographic study of inter-relationship of condylar guidance and anterior guidance in patients with physiological occlusion

Objetivo: O presente trabalho busca avaliar radiograficamente a possível inter-relação dos guias condiliana e anterior em pacientes com oclusão fisiológica. Material e métodos: Para tal, foram selecionadas telerradiografias laterais de 74 pacientes que foram divididos em dois grupos distintos, denominados grupo Um e grupo Dois. O grupo Um, constituído de 56 pacientes, apresentou trespasse horizontal igual a zero e oclusão fisiológica. Já o grupo Dois, composto de 18 participantes, apresentou trespasse horizontal diferente de zero. Foi realizada uma análise cefalométrica avaliada por meio da relação entre o plano de Frankfurt e a parede anterior da superfície articular do osso temporal e da face palatina dos incisivos superiores. Utilizou-se um transferidor de plástico, com variação de 0 a 180o, adaptado com um ponteiro fixado no seu centro e móvel, por meio do qual obteve-se as mensurações pela movimentação do ponteiro, cujos os dados foram anotados em uma ficha. Resultado: Do grupo Um, 52 (92,86%) apresentaram coincidência entre o guia condiliana guia anterior, e somente 4 pacientes (7,14%) não tiveram os guias coincidentes. Já o grupo Dois 17 pacientes (94,44%) apresentou guia anterior diferente da guia condiliana, e um paciente (5,56%) apresentou coincidência entre os guias. Conclusão: Com base nos resultados obtidos pode-se concluir que os guias condiliana e anterior apresentaram uma interrelação direta, que constituem parâmetros para a reconstrução e/ou posicionamento da guia anterior em tratamentos reabilitadores.

Objective: This study aims to evaluate radiographically the possible inter-relation of the condylar and previous guidances in patients with physiological occlusion. Methods: For this purpose, lateral cephalometric radiographs were selected from 74 patients who were divided into two distinct groups, called group one and group two. The group one consisting of 56 patients, showed overjet equal to zero and physiological occlusion. While group two, made up of 18 patients presented different overjet zero. The cephalometric analysis was evaluated through the relationship between the Frankfurt plane and the front surface wall joint of the temporal bone and the palatal face of the upper incisors was performed. It were used a plastic measuring protractor, ranging from 0 to 180o, fitted with a fixed pointer at its center and mobile, through which were obtained measurements by moving the pointer, whose data were recorded on a card. Results: From a group, 52 (92.86%) had coincidence between the condylar guidance and the previous guidance, and only 4 patients (7.14%) did not have the matching guidances. Already the group two 17 patients (94.44%) had different previous guide condylar guide, and one patient (5.56%) had coincidence between the guides. Conclusion: Based on the results it can be concluded that the condylar guidances and earlier had a direct inter-relation, which are parameters for reconstruction and / or positioning of the previous guidance rehabilitation treatments.

Efecto de los dispositivos oclusales sobre la vía aérea en pacientes con bruxismo / Effects of occlusal splints on upper airway in bruxism therapy

Objetivo Para el manejo de los trastornos temporomandibulares y del bruxismo de sueño (BS) se ha recurrido durante años a los dispositivos oclusales rígidos superiores (DORS). Estos dispositivos podrían modificar la posición de la mandíbula induciendo una posición más posterior de la lengua y del hueso hioides, comprometiendo la permeabilidad de la vía aérea superior y agravando los trastornos respiratorios del sueño. Este trabajo tiene como objetivo evaluar el cambio de las dimensiones lineales y de área de la luz de la vía aérea faríngea en pacientes diagnosticados con BS que estén usando un DORS, mediante una telerradiografía lateral. Metodología Se reclutaron 20 pacientes del Hospital de Carabineros, de ambos sexos, diagnosticados con BS probable manejados con un DORS, a los cuales se les tomó una telerradiografía lateral sin DORS y otra con DORS sin modificar la postura para evitar distorsiones por posición craneocervical. Se analizó el área y profundidad faríngea por medio de cefalometría para medir el espacio faríngeo. Resultados Se observaron diferencias estadísticamente significativas en la disminución del área de la orofaringe (promedio: 41,2 mm2, p = 0,035) y la profundidad al nivel del gonion (promedio: 0,38 mm, p = 0,019) y la úvula (promedio: 1,38 mm, p = 0,009). No se encontró correlación entre el aumento de la dimensión vertical y las diferencias dimensionales. Conclusión Bajo las condiciones de este estudio el uso de un DORS produce una tendencia a la disminución del área y profundidad orofaríngea.

Objective The use of the superior rigid occlusal splint (SROS) has been used to management temporomandibular disorders and sleep bruxism for many years. These SROS could change the mandibular position leading to a more posterior position of the tongue and hyoids bone, and compromising the upper airway flow permeability and make sleep-breathing disorders worse. The aim of this study is to evaluate the linear and area changes of lumen in patients with sleep bruxism who are using a SROS, measured by lateral teleradiograph. Methodology The study included 20 patients, of both sexes, from the Hospital de Carabineros, Chile, who were diagnosed with probable sleep bruxism due to using and SROS. The cephalometric analysis was performed of the area and pharyngeal depth in order to measure the pharyngeal space, by obtaining a lateral teleradiograph without SROS and a second teleradiograph using SROS, at the same time, to avoid dimensional variation due to possible craniocervical positional changes. Results A statistical significance was found for oropharynx reduction (mean: 41.2 mm2, P = .035), for the gonion linear depth (mean: 0.38 mm, P = .019), and at uvula level (mean: 1.83 mm, P = .009). No correlations were found between the increasing vertical dimensions using SROS and pharyngeal spaces. Conclusion The using of a superior occlusal splint (SROS) could reduce the oropharyngeal depth and space.

Visualización del plano oclusal y guía anterior en desdentados parciales en la telerradiografía lateral: descripción de la técnica a través de casos clínicos / Occlusal plane and anterior guidance visualization in lateral cephalometric radiographs in partially edentulous patients: technique description through case reports

El uso de la telerradiografía lateral ha tomado gran importancia en Rehabilitación Oral ayudando al clínico en el diagnóstico y planificación del tratamiento a través de la identificación del biotipo facial del paciente, la inclinación del plano oclusal, la relación anteroposterior entre maxilar y mandíbula, inclinación de los ejes dentarios y como ayuda complementaria en casos de alteraciones de la Dimensión Vertical. El problema surge cuando estamos frente a pacientes desdentados que han perdido puntos de referencia cefalométricos necesarios para el análisis. El presente trabajo muestra una técnica para poder visualizar radiográficamente el plano oclusal y la guía anterior utilizando láminas de plomo.

The use of lateral cephalometric radiographs has become very important in Oral Rehabilitation, helping the clinician in the diagnosis and treatment planning through the identification of facial biotype, occlusal plane inclination, sagittal relationship between maxilla and mandible, inclination of the dental axes, and a valuable help in assessing alterations of the vertical dimension of occlusion. The problem arises when treating partially edentulous patients who have lost their cephalometric reference points necessary for the analysis. This paper shows a technique to visualize the occlusal plane and anterior guidance in partially edentulous patients who have lost these anatomical landmarks in a lateral cephalometric radiograph, using lead sheets.

Análisis de los grosores tisulares a nivel de nasion y glabela según sexo y biotipo, en pacientes entre 20 y 27 años de edad / Nasion and glabela thickness tissue according to sex and biotypein patients between 20 and 27 years of age

La población chilena se caracteriza por ser una población muy heterogenea, debido a la gran mezcla exístente entre las distintas etnias y razas a lo largo del tiempo. Esto supone una gran diversidad de formas, tamaños y grosores de estructuras anatómicas, dentro de las cuales ubicamos a los grosores faciales. Si bien existen bases de datos de los grosores tisulares faciales en la población chilena, éstas han sido realizadas a través de técnicas como la ultrasonografía y punción, sin existir estudios realizados en Chile utilizando técnicas radiológicas para medir, como es la telerradiografía de perfil. Los objetivos fueron: 1. Medir los grosores tisulares a nivel de GB y NA, 2. Evaluar correlación de grosores según distribución por sexo y biotipo, 3. Comparar grosores entre distintos grupos, 4. Creación de una base de datos de referencia de la población chilena sobre el espesor del tejido blando a nivel de GB y Nay 5. Comparar los resultados obtenidos con otros estudios de grosores realizados en la población chilena. Se escogió al azar a 99 alumnos de odontología entre 20 a 27 años que necesitaban tratamiento de ortodoncia, a los cuales se les solicita una telerradiografía de perfil, en donde se mide los grosores de tejidos blandos a nivel de glabela y nasion, se clasifican a los pacientes según sexo y biotipo utilizando el análisis de Roth-Jaraback. Al analizar los resultados según sexo se observó siempre un grosor mayor en hombre que en mujer, con diferencia significativa a nivel de glabela y nasion. Al evaluar los resultados según biotipo no se observa diferencias siginificativas entre un biotipo y otro. Los hombres presentan un mayor grosor de tejido blando a nivel de glabela y nasion, con diferencia significativa en ambos. Se propone una nueva clasificación según biotipo, pero no se encuentra resultados concluyentes.

Chilean population is characterized for being heterogeneous, due to a large variety and mix of different ethnicities and races. This includes diversity in shapes, sizes and thickness of anatomic structures, part of which is facial thickness. Even though there are databases of facial tissue thickness for Chilean population, these have been carried out through techniques such as ultrasonography and puncture, without taking into consideration radiologic techniques, such as profile teleradiography. The aims of the study were: 1. Measure tissue thickness at GB and NA level, 2. Evaluate correlation in thickness according to distribution per sex and biotype. 3. Compare thickness among the groups. 4. Create a database of soft tissue thickness at GB and NA level in Chilean population, 5. Compare results with other studies regarding tissue thickness in Chilean population. Ninety-nine dentistry students between 20 and 27 years of age, candidates for orthodontic treatment, were randomly chosen. Lateral teleradiography was requested from all individuals, soft tissue thickness was measured at GB and NA level, classifying patients according to Roth-Jaraback analysis. When analysing the results according to sex, larger thickness was observed in men each time, with a significant difference at GB and NA levels. When evaluating biotype differences no significant difference was observed. Men showed thicker soft tissue at NA and GB level than women, with a significant difference between both. A new classification is proposed according to biotype, but no concluding data is found.

Correlation between transverse and vertical measurements in Brazilian growing patients, evaluated by Ricketts-Faltin frontal analysis

INTRODUCTION: Currently in orthodontic diagnosis, besides the lateral cephalometric analysis which evaluates the anteroposterior and vertical direction, the frontal analysis may be added, leading us to another important dimension in space: the transverse dimension. OBJECTIVE: Few longitudinal samples with the frontal radiograph were published, so this cephalometric study was designed to correlate the transversal and vertical measures by Ricketts-Faltin frontal analysis into two radiographic times. METHODS: The sample consisted of 45 Brazilian children, 25 girls and 20 boys, all presenting mixed dentition, with balanced facial aesthetics and no previous orthodontic/orthopedic treatment. The initial average age (T1) was 7.7 years and the final (T2) 13.3 years. The measurements evaluated were: FTD, MxTD, NTD, LITD, MdTD (transversal), OVD and TVD (vertical). RESULTS: All transversal measures were positively correlated with a medium or high correlation with each other and the vertical measurements; only LITD presented a low correlation with these measurements. CONCLUSION: It was concluded that the face has interdependent regions and that this feature remains with growth.

INTRODUÇÃO: atualmente no diagnóstico ortodôntico, além da análise cefalométrica lateral - que avalia os sentidos anteroposterior e vertical -, deve-se acrescentar a análise no sentido frontal, a qual propicia outra dimensão importante no espaço, a transversal. OBJETIVO: poucas são as amostras longitudinais publicadas utilizando telerradiografias frontais; portanto, o presente estudo cefalométrico teve o intuito de correlacionar as medidas transversais e verticais por meio da análise frontal de Ricketts-Faltin, em dois tempos radiográficos. MÉTODOS: a amostra constou de 45 crianças brasileiras, sendo 25 meninas e 20 meninos, todos apresentando dentição mista, com perfil harmonioso e sem nunca terem sido tratadas ortodonticamente e/ou ortopedicamente. A idade média inicial (T1) foi de 7,7 anos e a final (T2) de 13,3 anos. As medidas avaliadas foram: DTF, DTMx, DTN, DTII e DTMd (transversais); DVO e DVT (verticais). RESULTADOS: todas as medidas transversais estavam correlacionadas positivamente, em grau médio ou forte, entre si e com as medidas verticais; somente DTII estava correlacionada em grau fraco com essas medidas. CONCLUSÃO: concluiu-se que a face possui regiões interdependentes, e assim mantém-se mesmo com o crescimento.

Estudo comparativo entre dois métodos simplificados de avaliação dos estágios do surto de crescimento da puberdade / Comparative study of two simplified evaluation methods of the stages of pubertal growth spurt

Este estudo objetivou avaliar e comparar dois dos métodos mais utilizados para a determinação da maturação esquelética humana, a saber, a radiografia de mão e punho e análise das vértebras cervicais da telerradiografia em norma lateral. Foram avaliadas tais radiografias cefalométricas e mão e punho de 34 pacientes, de ambos os gêneros, na faixa etária de 7 a 17 anos, do acervo do curso de especialização em Ortodontia e Ortopedia Facial da ABO-SE. As radiografias foram analisadas apenas por um examinador, em dois tempos, com intervalo de 30 dias. A determinação do estágio de maturação esquelética pela avaliação das vértebras cervicais foi realizada pelo método utilizado por Baccetti et al.2 (2005), modificado a partir do estudo de Lamparski7 (1975) e classificado de acordo com os resultados encontrados nos estudos de Lara8 (2008). Entretanto, para a análise da radiografia carpal, utilizou-se o método proposto por Sakima & Toledo. As classificações obtidas com os dois métodos foram comparadas utilizando o teste estatístico de Kappa. Ambos foram considerados como métodos válidos e úteis, porém a classificação simplificada adotada no presente estudo do estágio de maturação esquelética em relação ao surto de crescimento mostrou-se ainda impreciso, necessitando de mais estudos

This study aimed to evaluate and compare the two methods used for the determination of human skeletal maturation, namely the hand and wrist etermination and analysis of cervical vertebrae in lateral cephalograms. These cephalograms and hand and wrist radiography of 34 patients, both genders and aged 7-17 years, from the collection of the specialization course in Orthodontics and Facial Orthopedics ABO-SE, were analyzed. The analysis was performed by only one examiner on two occasions with an interval of 30 days. Determination of skeletal maturation stage through cervical vertebrae was performed by the method used by Baccetti et al.2 (2005), modified from Lamparski´s study7 (1975) and classified according to the results found in Lara´s studies8 (2008). For the analysis of carpal radiographs, we used the method proposed by Toledo & Sakima. The classifications obtained with both methods were compared using the Kappa statistical test. Both methods were considered valid and useful, but the simplified classification adopted in this study of the stage of skeletal maturation in relation to the growth spurt is still uncertain requiring further studies.

Sindrome de Crouzon: diagnóstico radiográfico y tratamiento ortognático de un caso clínico / Crouzon´s syndrome: radiographic diagnosis and orthognathic treatment of a clinical case

El síndrome de Crouzon es un defecto de origen congénito que se caracteriza por malformaciones en el desarrollo, ligado al cierre prematuro de las suturas craneales que producen severos cambios en la conformación de la cara y cráneo. El objetivo de este trabajo es presentar un caso clínico de un paciente con síndrome de Crouzon de 17 años de edad, sexo femenino. Se analizan los diagnósticos clínico, radiográfico y elt ratamiento ortodóntico-quirúrgico.

Estudo comparativo da tomografia computadorizada de feixe cônico e da radiografia cefalométrica lateral no diagnóstico ortodôntico / Comparative study of Cone Beam Computed Tomografy and the lateral Cephalometric Radiography in Orthodontic Diagnosis

Introdução - O objetivo desse estudo foi comparar a precisão de dimensões lineares feitas de alguns pontos cefalométricos selecionados na telerradiografia convencional e na tomografia computadorizada de feixe cônico tendo como base medidas feitas diretamente em crânios secos. Material e Métodos - O material deste estudo consistiu de 2 (dois) crânios secos nos quais selecionou-se 8 (oito) pontos cefalométricos e 10 (dez) medidas lineares ortodônticas. A análise dos dados foi realizada mediante um estudo comparativo entre as medidas obtidas na telerradiografia convencional e na tomografia computadorizada de feixe-cônico através do aparelho Newton 3G com auxílio do software NNT. Resultados - As medidas obtidas na tomografia computadorizada se mostraram mais próximas as medidas reais dos crânios, porém não podemos desconsiderar as medidas obtidas na telerradiografia que também se mostraram confiáveis. Conclusões - O uso da tomografia computadorizada de feixe-cônico associada a computação gráfica é uma nova tendência na Ortodontia. Os novos métodos de obtenção de imagens modificarão definitivamente a maneira com que visualizamos o complexo craniofacial, servindo de grande auxiliar no diagnóstico e no planejamento ortodôntico.

Introduction - The objective this study was to compare the precision of dimensons linears made of some points in cephalometric selected in telerradiography convencional and Cone Beam Computed Tomografy with base in measure made direct in cranium dry. Material and Methods - The material of this study constituted of 2 (two) cranium dry where was selected 8 (eigth) points cephalometric, and 10(ten) linears measure orthodontics. The analysis of data was designed means of study comparative between, measure obtained in telerradiography convencional and Cone Beam Computed Tomografy using a equipment Newton 3G with assistant of software NNT. Results - The measure obtained in tomography computerized showed reals measure of cranium, but have to consider the measures obtained in telerradiography that showed trustfull too. Conclusions - The use of tomography computerized of beam –conical associated with computation graph is a new tendency of orthodontics. The news methods to obtain images with modify the form definitive that visualize the complex craniofacial that’s large assistant in diagnosis and planning orthodontic.

Bosquejo histórico de la Cefalometría Radiográfica / Historical sketch of radiographic cephalometry

La cefalometría es un elemento importante en la conformación de una documentación ortodóncica para elaborar un diagnóstico y un plan de tratamiento adecuado. Con el descubrimiento de los rayos X, el 8 de noviembre de 1895 por Wilhhelm Conrad Roentgen, y la existencia de técnicas que precedieron a los rayos X, como la craneometría y la antropología, es que los ortodoncistas pueden contar con esta herramienta diagnóstica de inestimable valor. En el perfeccionamiento de la técnica cefalométrica y de sus análisis contemporáneos ha sido importante el concurso de diversos autores entre los que se destacan Broadbent, Bolton, Hofrath, Korkhaus, Ubaldo Carrea, De Nevreze, Paul Simon y Dreyfus, Margolis, Weingart, Thurow, Bjork, Freeman-Rasmussen, Reboul, Steiner, Andrews, Ricketts, Holdaway, McNamara, Interlandi, entre otros. Este trabajo se propone hacer un recuento de los hechos más significativos que acompañaron la evolución y desarrollo de la cefalometría(AU)

Cephalometry is an important element to take into account at the time of preparing an orthodontic documentation in order to make a diagnosis and an adequate treatment plan. Thanks to the discovery of X-rays on November 8, 1895 by Wilhhelm Conrad Roentgen, and to the existence of techniques that preceded the X-rays, such as craniometry and anthropology, orthodontists may use this diagnostic tool of great value. In the improvement of the cephalometric technique and its contemporary analyses it has been important the collaboration of various authors, among whom Broadbent, Bolton, Hofrath, Korkhaus, Ubaldo Carrea, De Nevreze, Paul Simon and Dreyfus, Margolis, Weingart, Thurow, Bjork, Freeman-Rasmussen, Reboul, Steiner, Andrews, Ricketts, Holdaway, McNamara and Interlandi, stand out. This paper intends to make an account of the most significant events related to the evolution and development of cephalometry(AU)

Bosquejo histórico de la Cefalometría Radiográfica / Historical sketch of radiographic cephalometry

La cefalometría es un elemento importante en la conformación de una documentación ortodóncica para elaborar un diagnóstico y un plan de tratamiento adecuado. Con el descubrimiento de los rayos X, el 8 de noviembre de 1895 por Wilhhelm Conrad Roentgen, y la existencia de técnicas que precedieron a los rayos X, como la craneometría y la antropología, es que los ortodoncistas pueden contar con esta herramienta diagnóstica de inestimable valor. En el perfeccionamiento de la técnica cefalométrica y de sus análisis contemporáneos ha sido importante el concurso de diversos autores entre los que se destacan Broadbent, Bolton, Hofrath, Korkhaus, Ubaldo Carrea, De Nevreze, Paul Simon y Dreyfus, Margolis, Weingart, Thurow, Bjork, Freeman-Rasmussen, Reboul, Steiner, Andrews, Ricketts, Holdaway, McNamara, Interlandi, entre otros. Este trabajo se propone hacer un recuento de los hechos más significativos que acompañaron la evolución y desarrollo de la cefalometría(AU)

Cephalometry is an important element to take into account at the time of preparing an orthodontic documentation in order to make a diagnosis and an adequate treatment plan. Thanks to the discovery of X-rays on November 8, 1895 by Wilhhelm Conrad Roentgen, and to the existence of techniques that preceded the X-rays, such as craniometry and anthropology, orthodontists may use this diagnostic tool of great value. In the improvement of the cephalometric technique and its contemporary analyses it has been important the collaboration of various authors, among whom Broadbent, Bolton, Hofrath, Korkhaus, Ubaldo Carrea, De Nevreze, Paul Simon and Dreyfus, Margolis, Weingart, Thurow, Bjork, Freeman-Rasmussen, Reboul, Steiner, Andrews, Ricketts, Holdaway, McNamara and Interlandi, stand out. This paper intends to make an account of the most significant events related to the evolution and development of cephalometry(AU)