Evaluation of orthodontic habits regarding the use of miniplates in the correction of Skeletal Class III.

AIMS: To determine the habits of Orthodontists in the management of moderate skeletal class III patients by using miniplates, and to assess the relationship between the factors that may hinder the implementation of such treatment. MATERIAL AND METHODS: A questionnaire was carried out using the Google Form® platform, which included 18 questions relating to the seniority of the practice of the orthodontists, the preferential treatment, the difficulties encountered, the results obtained, and the frequency of a relapse. RESULTS: Experienced orthodontists (more than 10 years) treated skeletal class III malocclusion with the conventional facemask therapy, whereas orthodontists with less than 5 years of experience shifted to the miniplate technique which presented less dental effect and more skeletal correction with a decreased frequency of relapse. CONCLUSION: High financial cost and increased care load were considered the main obstacles regarding the placement of the titanium miniplates in treating skeletal class III patients.

Maxillary Protraction: A Bibliometric Analysis.

OBJECTIVES: The aim of this analysis was to investigate the historical development, current status, and research hot spots related to maxillary protraction in the treatment of maxillary hypoplasia. METHODS: The term "TS = maxillary protraction" was used to search for articles in the Web of Science Core Collection at the library of Capital Medical University. The results were analysed using CiteSpace6.2.R1 software, including the examination of annual publication trends and analysis of author, country, institution, and keywords. RESULTS: A total of 483 papers were included in this study. The annual publications showed an overall increasing trend. The top 5 authors with the most published papers were Lorenzo Franchi, Tiziano Baccetti, Seung-Hak Baek, Paola Cozza, and U Hagg. The top 5 countries with the highest publication counts were the US, Turkey, South Korea, Italy, and China. The top 5 institutions in terms of the number of published papers were the University of Florence, the University of Michigan, Kyung Hee University, Seoul National University, and Gazi University. The top 3 journals with the most citations were the American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, and the European Journal of Orthodontics. Furthermore, "Maxillary protraction," "Class III malocclusion," and "Maxillary expansion" were the most common keywords. CONCLUSIONS: The effective age range for maxillary protraction has been expanded with the introduction of skeletal anchorage and the combination of maxillary expansion and protraction. Skeletal anchorage offers significant advantages over dental anchorage, but there is a need for further research to further substantiate its stability and safety. In recent years, the positive effects of maxillary protraction on the nasopharyngeal area have been well established, but its impact on the oropharyngeal area remains a topic of debate. Therefore, it is crucial to conduct further investigations into the effects of maxillary protraction on the oropharyngeal area and explore the factors that influence different outcomes.

How much should incisors be decompensated? periodontal bone defects during presurgical orthodontic treatment in class III double-jaw orthognathic surgery patients.

INTRODUCTION: The aims of this study were to evaluate periodontal bone defects around the lower and upper incisors and to identify changes in the buccolingual inclination of the incisors during orthodontic decompensation in skeletal Class III orthognathic surgery patients. MATERIALS AND METHODS: The sample consisted of 26 adults with skeletal Class III deformity who had undergone presurgical orthodontic treatment and orthognathic surgery. Lateral cephalograms obtained before orthodontic treatment and before surgery were used to determine the inclination and position changes of the incisors. Cephalometric measurements were taken using Dolphin Imaging 11.95. Three-dimensional images were generated from cone-beam computed tomography (CBCT) scans prior to surgery and used to detect periodontal bone defects, including fenestration (F) and dehiscence (D). RESULTS: Intraclass correlation coefficients (ICC) were determined and the measurements showed high reproducibility. The cephalometric data showed normal distribution and there were no differences between genders in terms of cephalometric changes, dehiscence, fenestration, or coexistent (D-F/DF) formation. The patients presented maxillary incisor retroclination and mandibular incisor proclination, which was consistent with the tooth decompensation. CBCT assessment was performed for a total of 208 teeth; while 81 upper and 94 lower incisors had D-F/DF formation, 23 upper and 10 lower incisors were healthy. Statistically significant correlations were not found between the inclination degree of the incisors and D-F/DF formation. CONCLUSIONS: Decompensation of incisors during presurgical orthodontic treatment increases the risk of periodontal defects. There is no linear relationship between the increase in the inclination degrees of incisors and D-F/DF formation.

A heuristic model for cephalometric diagnosis of sagittal dysplasia.

OBJECTIVE: To identify the best-suited cephalometric parameter for assessing the sagittal skeletal discrepancy in the Indian population. DESIGN: An in vitro, observational, single-blinded, retrospective study. SETTING: Department of Orthodontics and Dentofacial Orthopaedics. METHODS: A total of 94 lateral cephalograms were used in this study. The study involved one key person and two examiners. The key person collected the radiographs, coded, analysed and classified them into three groups (skeletal classes I, II and III). Subsequently, the coded radiographs were independently analysed by the two examiners. They classified the cases by matching a minimum of 6 out of 11 parameters. On completion of diagnosis by the examiners, the samples were decoded and matched with the original diagnosis given by the key person. The samples in which identification of a particular cephalometric parameter matched the original evaluation as given by the key person was regarded as correctly diagnosed. The number of correctly assessed cases was used to judge the diagnostic performance of all the parameters in all the cases. Cross-validation of the method was performed, and a diagnostic algorithm was developed for diagnosis. RESULTS: ß angle and Pi angle showed a positive predictive value of 1 in both skeletal class I and II cases. ANB angle, W angle and HBN angle showed a positive predictive value of 1 in skeletal class III cases. CONCLUSION: No single cephalometric parameter can independently be used to diagnose sagittal skeletal discrepancy in all cases. However, a conclusive diagnosis on the type of sagittal skeletal malocclusion can be made by using a simple and easy to use diagnostic algorithmic process having a combination of cephalometric parameters.

Diagnóstico e tratamento precoce da má oclusão de Classe III com Aparelho Disjuntor Hyrax e Máscara Facial de Petit com avaliação do tempo de uso com micro-sensor: relato de caso clínico / Early diagnosis and treatment of Class III occlusion with Hyrax Isolating Appliance and Petit Face Mask with evaluation of the time of use with micro-sensor: a clinical case report

O sucesso do tratamento precoce da classe III depende de um bom diagnóstico e da cooperação do paciente na utilização do aparelho extrabucal. Neste trabalho, por meio de um chip (Theramon) instalado na Máscara Facial de Petit da paciente, foi possível monitorar a quantidade de horas que a paciente utilizou o aparelho por dia, durante um período de quatro meses. Paciente do sexo feminino, 7 anos e 11 meses de idade portadora da má oclusão de classe III, utilizou o aparelho de disjunção da maxila (Hyrax) modificado, seguido da Máscara Facial de Petit com chip (Theramon) instalado. A média de uso foi maior do que 11 horas de uso diário. O uso deste dispositivo auxilia no monitoramento do tempo de uso do aparelho, cujo sucesso do tratamento depende da utilização deste pelo paciente(AU)

The success of early treatment of class III depends on a good diagnosis and the cooperation of the patient in the use of the extra oral appliance. In this study, the patient was able to monitor the number of hours the patient used the device per day during a period of four months using a Theramon chip installed in the Patient's Facial Mask. A 7-year, 11-month-old male with Class III malocclusion used the modified maxillary disjunction (Hyrax), followed by the Petit Facial Mask with a Theramon chip installed. The average use was greater than 11 hours of daily use. The use of this device assists in the monitoring of the time of use of the device, whose success of the treatment depends on the use of this by the patient(AU)

Surgical Treatment of a Borderline Skeletal Class III Patient: an Interdisciplinary Approach.

INTRODUCTION: Class III malocclusion is considered the most challenging discrepancies in orthodontic diagnosis and treatment planning. It is often difficult to classify borderline cases as surgical or non-surgical. The following case report is of a borderline Class III case with several missing maxillary premolars treated via an interdisciplinary approach. AIM: This clinical case highlights the importance of meticulous diagnosis to obtain optimal results in borderline Class III cases. The significance of an interdisciplinary approach in complex adult orthodontic cases was also discussed. CASE REPORT: Given the complexity of the case, the treatment required a comprehensive interdisciplinary approach with the intervention of multiple specialties including periodontics, prosthodontics, orthodontics, oral surgery and maxillofacial surgery. The presurgical orthodontic stage was achieved in preparation for LeFort I maxillary advancement. Third molars extractions along with implant placement were implemented. Finally, crown placement and connective tissue graft were completed to achieve an optimal result. Total treatment time was 1.7 years (20 months). Patient's profile and facial appearance were dramatically enhanced, and a stable functional Class II occlusion was attained despite the preexisting skeletal Class III. CONCLUSION: Borderline adult Class III cases require a delicate diagnostic approach to be able to distinguish a surgical from a non-surgical approach. Complex adult orthodontic cases require a diplomatic interdisciplinary approach from all required specialties in order to attain the most favorable results.

Craniofacial growth predictors for class II and III malocclusions: A systematic review.

OBJECTIVE: To evaluate the validity of craniofacial growth predictors in class II and III malocclusion. MATERIAL AND METHODS: An electronic search was conducted until August 2020 in PubMed, Cochrane Library, Embase, EBSCOhost, ScienceDirect, Scopus, Bireme, Lilacs and Scielo including all languages. The articles were selected and analyzed by two authors independently and the selected studies was assessed using the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The quality of evidence and strength of recommendation was assessed by the GRADE tool. RESULTS: In a selection process of two phases, 10 articles were included. The studies were grouped according to malocclusion growth predictor in (1) class II (n = 4); (2) class III (n = 5) and (3) class II and III (n = 1). The predictors were mainly based on data extracted from cephalometries and characterized by: equations, structural analysis, techniques and computer programs among others. The analyzed studies were methodologically heterogeneous and had low to moderate quality. For class II malocclusion, the predictors proposed in the studies with the best methodological quality were based on mathematical models and the Fishman system of maturation assessment. For class III malocclusion, the Fishman system could provide adequate growth prediction for short- and long-term. CONCLUSIONS: Because of the heterogeneity of the design, methodology and the quality of the articles reviewed, it is not possible to establish only a growth prediction system for class II and III malocclusion. High-quality cohort studies are needed, well defined data extraction from cephalometries, radiographies and clinical characteristics are required to design a reliable predictor.

[Treatment is not diagnostic. Therapeutic common sense regarding class III dysmorphia]. / Traitement n'est pas diagnostic. Le bon sens thérapeutique face à la dysmorphie de classe III.

Class III dysmorphia, classically distributed in hereditary or functional etiology, have often multifactorial causes. Breaking the dysmorpho-dysfunctional cascade with early treatment may seem to be an essential alternative to give growth a new orientation. Whether the treatments are preventive, interceptive with or without an appliance, orthodontic or surgical (early, first-line or late), this takes more account of the clinical form than of age. The authors, through clinical cases, will develop their therapeutic approach, based on clinical common sense. Waiting to act at the right time is essential to set up treatments based on proven therapies.

Effect of face mask therapy on mandibular rotation considering initial and final vertical growth pattern: A longitudinal study.

Objectives: To evaluate the effect of maxillary protraction with facemask therapy on mandibular rotation taking into account the initial and final vertical growth pattern of each participant in order to evaluate our null hypothesis: The use of facemask in these patients does not modify their initial vertical growth pattern. Material and Methods: A prospective single cohort study included children with Class III malocclusion treated with rapid palatal expansion and maxillary protraction with facemask. Cephalograms were taken before commencement and after completion of the facemask therapy with standardized equipment and magnification. Intraindividual cephalometric measurements were compared, and the vertical growth patterns were classified according to cephalometric standards. Potential changes in vertical growth pattern before and after completion of the facemask therapy was assessed by measuring Pearson's chi­square and by multiple correspondence analysis. Results: Thirty­eight study participants were recruited, aged between 5.2 to 9.5 years (mean 7.5) at the commencement of facemask therapy, which lasted on average 1.6 years. Differences on pretherapy and posttherapy cephalograms were seen for linear rotational and sagittal measurements (p < .01) as well as angular measurements of the cranial base, including an average palatal plane rotation of 0.45° (standard deviation: 1.78) and an average mandibular rotation of 0.39° (standard deviation: 2.19). The majority of participants maintained their initial vertical growth pattern after facemask therapy according to the multiple correspondence analysis (p < .001). Conclusion: Facemask therapy does not modify vertical growth pattern. The observed changes suggest a trend of maintaining each patient's initial growth direction after therapy.

Similarity index for intuitive assessment of three-dimensional facial asymmetry.

Evaluation of facial asymmetry generally involves landmark-based analyses that cannot intuitively assess differences in three-dimensional (3D) stereoscopic structures between deviation and non-deviation sides. This study tested a newly developed similarity index that uses a mirroring technique to intuitively evaluate 3D mandibular asymmetry, and characterised the resulting lower facial soft tissue asymmetry. The similarity index was used to evaluate asymmetry before and after surgery in 46 adult patients (27 men, 19 women; age, 22 ± 4.8 years) with skeletal Class III malocclusion and facial asymmetry who underwent conventional bimaxillary orthognathic surgery. Relative to the midsagittal plane used as the reference plane, the non-overlapping volume of the mandible significantly decreased, and the similarity index significantly increased after surgery. Similarity indexes of the mandible and lower facial soft tissue were strongly negatively correlated with non-overlapping volumes of each measurement. Differences in bilateral hemi-mandibular and hemi-lower facial soft tissue surface and volume measurements before surgery were significantly negatively correlated with similarity indexes of the mandible before and after surgery. This newly developed similarity index and non-overlapping volume using a mirroring technique can easily and intuitively evaluate overall 3D morphological discrepancies, especially 3D mandibular asymmetry, before and after surgery in skeletal Class III patients with facial asymmetry.

Maxillary protaction with zygomatic anchorage in a growing class III patient.

Maxillary protraction headgear with dental anchorage is commonly used in the treatment of class III malocclusion, but this treatment has been shown to have certain undesirable effects such as the loss of dental anchorage. These side effects can be reduced with the use of skeletal anchorage such as miniplates, mini screws and implants. This case report describes an orthopaedic treatment performed on a 10-year-old boy presenting a class III malocclusion with maxillary hypoplasia, for which a 10-month first phase of maxillary protraction was realised with zygomatic miniplates used as a skeletal anchorage. As a result, significant skeletal, dental and facial changes were observed.

ADAMTSL1 and mandibular prognathism.

Mandibular prognathism is characterized by a prognathic or prominent mandible. The objective of this study was to find the gene responsible for mandibular prognathism. Whole exome sequencing analysis of a Thai family (family 1) identified the ADAMTSL1 c.176C>A variant as the potential defect. We cross-checked our exome data of 215 people for rare variants in ADAMTSL1 and found that the c.670C>G variant was associated with mandibular prognathism in families 2 and 4. Mutation analysis of ADAMTSL1 in 79 unrelated patients revealed the c.670C>G variant was also found in family 3. We hypothesize that mutations in ADAMTSL1 cause failure to cleave aggrecan in the condylar cartilage, and that leads to overgrowth of the mandible. Adamtsl1 is strongly expressed in the condensed mesenchymal cells of the mouse condyle, but not at the cartilage of the long bones. This explains why the patients with ADAMTSL1 mutations had abnormal mandibles but normal long bones. This is the first report that mutations in ADAMTSL1 are responsible for the pathogenesis of mandibular prognathism.

Relación entre oclusión dentaria y postura cráneo-cervical en niños con maloclusiones clase II y III / Relationship between dental occlusion and craniocervical posture in children with class II and III malocclusions

RESUMEN Introducción: la relación entre las maloclusiones y la postura del sistema cráneo cervical ha generado un interés creciente entre los ortodontistas. Objetivo: describir la relación entre la oclusión dentaria y la postura del sistema cráneo-cervical en niños con maloclusiones clase II y clase III. Materiales y métodos: estudio descriptivo transversal. El universo estuvo formado por 19 niños, de 7 a 12 años, con maloclusiones clase II y III de Angle. Ingresados en el Servicio de Ortodoncia de la Facultad de Estomatología de La Habana, en octubre del 2016. Se realizó examen bucal y telerradiografía. Los resultados se presentaron en tablas. Resultados: predominó la clase II de Angle, donde la distoclusión molar fue más marcada en el lado derecho (-2,95 mm) y en la clase III la mesioclusión mayor correspondió al izquierdo (2,25 mm como promedio). En ambas predominó la ½ unidad (36,8 % en clase II). El ángulo cráneo-vertebral y el espacio suboccipital estuvieron dentro del rango normal; 104,65º y 7,99 mm, en clase II y en clase III, 103,78º y 6,90 mm como promedio. La profundidad de la columna cervical fue 6,26 mm y 6,20 mm respectivamente; lo que significó una rectificación de columna cervical. Conclusiones: se encontró más frecuente la clase II de Angle. La posición de la cabeza fue normal en ambas clases y la columna cervical rectificada. Se identificaron relaciones inversas entre la magnitud de la maloclusión con la posición de la cabeza y la columna cervical.

ABSTRACT Introduction: the relationship between malocclusions and the crania-cervical system posture has generated a a growing interest among orthodontists. Objective: to describe the relationship between dental occlusion and the position of the crania-cervical system in children with class II and class III malocclusions. Materials and methods: cross-sectional, descriptive study. The universe was 19 children, aged from 7 to 12 years, class II and III Angle's malocclusions, admitted in the Orthodontics service of the Faculty of Stomatology of Havana in October 2016. Oral examination and teleradiography were performed. The results were presented in tables. Results: Class II of Angle predominated, where the molar distoclusion was more marked on the right side (-2.95 mm) and in class III the greater mesioclusion corresponded to the left (2.25 mm as average). In both, the ½ unit predominated (36.8% in Class II). The cranio-vertebral angle and the suboccipital space were within the normal range; 104.65º and 7.99 mm in class II and in class III 103.78º and 6.90 mm as average. The depth of the cervical spine was 6.26 mm and 6.20 mm respectively; which meant a rectification of the cervical spine. Conclusions: Angle's Class II was found more frequent. The position of the head was normal in both classes and also the rectified cervical spine. Inverse relationships were identified between the magnitude of the malocclusion and the position of the head and cervical spine. The objective of this work is to present a clinical case and the importance of a nurse intervention.

Sensitivity and Specificity of Cephalometric Measures for the Diagnosis of Sagittal Skeletal Malocclusion

Objective: To evaluate and compare sensitivity and specificity of ANB, Wits, APDI and AF-BF to diagnose sagittal skeletal malocclusions, in children between 6 to 12 years old, using ROC curves, a widely accepted method for the analysis and evaluation of diagnostic tests. Material and Methods: A descriptive-comparative study of diagnostic tests was conducted. From a population of 3,000 children, a non-probabilistic sample of 209 was selected. The clinical classification of the patients as class I, II or III, made by a group of experts based on the visual inspection of models and photographs, was chosen as the gold standard. After calibration (ICC>0.94) the variables were measured in cephalograms. Eight ROC curves were plotted (I vs II, and I vs III for each one of the variables). The area under the curve was measured and compared (Ji-square test). Cut points were established. Results: To discriminate Class I from II, ANB showed the largest area under the curve (AUC) (0.876) and the cut point (best sensitivity and specificity) was at 5.75°. To discriminate class I from III, Wits showed the largest AUC (0.874) with a cut point of -3.25 mm. There were no statistical differences between the AUC for the four variables (p=0.48 y p=0.38 for class I-II and I-III). Conclusion: ANB and Wits performed better for the diagnosis of class II and III, respectively. Cut points in children were different from those reported in adults.

Relación entre oclusión dentaria y postura cráneo-cervical en niños con maloclusiones clase II y III / Relationship between dental occlusion and craniocervical posture in children with class II and III malocclusions

RESUMEN Introducción: la relación entre las maloclusiones y la postura del sistema cráneo cervical ha generado un interés creciente entre los ortodontistas. Objetivo: describir la relación entre la oclusión dentaria y la postura del sistema cráneo-cervical en niños con maloclusiones clase II y clase III. Materiales y métodos: estudio descriptivo transversal. El universo estuvo formado por 19 niños, de 7 a 12 años, con maloclusiones clase II y III de Angle. Ingresados en el Servicio de Ortodoncia de la Facultad de Estomatología de La Habana, en octubre del 2016. Se realizó examen bucal y telerradiografía. Los resultados se presentaron en tablas. Resultados: predominó la clase II de Angle, donde la distoclusión molar fue más marcada en el lado derecho (-2,95 mm) y en la clase III la mesioclusión mayor correspondió al izquierdo (2,25 mm como promedio). En ambas predominó la ½ unidad (36,8 % en clase II). El ángulo cráneo-vertebral y el espacio suboccipital estuvieron dentro del rango normal; 104,65º y 7,99 mm, en clase II y en clase III, 103,78º y 6,90 mm como promedio. La profundidad de la columna cervical fue 6,26 mm y 6,20 mm respectivamente; lo que significó una rectificación de columna cervical. Conclusiones: se encontró más frecuente la clase II de Angle. La posición de la cabeza fue normal en ambas clases y la columna cervical rectificada. Se identificaron relaciones inversas entre la magnitud de la maloclusión con la posición de la cabeza y la columna cervical (AU).

ABSTRACT Introduction: the relationship between malocclusions and the crania-cervical system posture has generated a a growing interest among orthodontists. Objective: to describe the relationship between dental occlusion and the position of the crania-cervical system in children with class II and class III malocclusions. Materials and methods: cross-sectional, descriptive study. The universe was 19 children, aged from 7 to 12 years, class II and III Angle's malocclusions, admitted in the Orthodontics service of the Faculty of Stomatology of Havana in October 2016. Oral examination and teleradiography were performed. The results were presented in tables. Results: Class II of Angle predominated, where the molar distoclusion was more marked on the right side (-2.95 mm) and in class III the greater mesioclusion corresponded to the left (2.25 mm as average). In both, the ½ unit predominated (36.8% in Class II). The cranio-vertebral angle and the suboccipital space were within the normal range; 104.65º and 7.99 mm in class II and in class III 103.78º and 6.90 mm as average. The depth of the cervical spine was 6.26 mm and 6.20 mm respectively; which meant a rectification of the cervical spine. Conclusions: Angle's Class II was found more frequent. The position of the head was normal in both classes and also the rectified cervical spine. Inverse relationships were identified between the magnitude of the malocclusion and the position of the head and cervical spine. The objective of this work is to present a clinical case and the importance of a nurse intervention (AU).

Maxillofacial morphological factors related to acceleration of maxillary growth attributed to facial mask treatment: a structural superimposition study.

BACKGROUND: Anatomical textbooks mention that the contact between the pterygoid process and the palatine's pyramidal process is not a "suture" but "conjugation.".The aim was to evaluate the maxillofacial morphological factor responding most to the orthopedic force of facial mask treatment, using the structural superimposition analysis. METHODS: Thirty-one girls with Angle Class III malocclusion treated using a facial mask (FM group) and 11 girls with pseudo-Class III malocclusion (pseudo-III group) were examined. Lateral cephalograms at pre- and posttreatment were analyzed to evaluate maxillofacial changes. Cephalometric structural superimposition analysis originating with Björk and Skieller was also performed. RESULTS: In the FM group, a multiple linear regression model showed that maxillary sutural growth was significantly associated with counter-clockwise rotation of the maxilla and treatment changes in the anteroposterior distance from the pterygomaxillary fissure to the maxillary anterior alveolus, not changes in the distance from the nasion to the maxillary anterior alveolus. CONCLUSIONS: Structural superimposition analysis showed that counter-clockwise rotation of the maxilla and changes in the distance from the pterygomaxillary fissure to the maxillary anterior alveolus responded most to the orthopedic force of facial mask treatment. The analysis implicated that the pterygoid fissure-palatine's pyramidal process conjugation responds most to facial mask treatment among maxillofacial sutures and conjugation, and that the difference in the response induces maxillary counter-clockwise rotation.

Evaluations of the tongue and hyoid bone positions and pharyngeal airway dimensions after maxillary protraction treatment.

OBJECTIVE: To assess changes in the tongue and hyoid bone positions and airway dimensions after maxillary protraction using lateral cephalograms. METHODS: Lateral cephalograms were obtained before (C0) and after (C1) an observation period for untreated children with skeletal Class I malocclusion and before (T0), immediately after (T1), and one year after (T2) maxillary protraction in children with skeletal Class III malocclusion. Cephalometric measurements were compared between the time points in both patient groups. RESULTS: Immediately after maxillary protraction, the tongue moved superiorly and the nasopharyngeal and superior oropharyngeal airway dimensions increased. No significant changes in the middle or inferior oropharyngeal airway dimensions or in the hyoid bone position were noted after treatment. CONCLUSIONS: Maxillary protraction improved tongue posture and modified the nasopharyngeal and superior oropharyngeal airway dimensions in patients with skeletal Class III malocclusion. Consequently, maxillary protraction may restore the intra- and extraoral balance and improve respiratory function.

Tratamentos precoces classe III com ancoragem esquelética comparado a ortopedia facial: revisão sistemática / Early treatments class III with skeletal anchorage compared to facial orthopedic: systematic review

A classe III esquelética representa a discrepância no crescimento ósseo maxila e/ou mandíbula, podendo estar associada à retrusão maxilar, protrusão mandibular ou combinação das duas condições. Essas condições refletem em prejuízos estéticos e funcionais ao paciente. Recentemente, a ancoragem esquelética foi idealizada como alternativa no tratamento precoce da classe III. Essa técnica tem o objetivo corrigir a discrepância óssea, minimizar os efeitos adversos da máscara facial e eliminar o aparato extra bucal. O objetivo do trabalho foi avaliar a efetividade da ancoragem esquelética comparada a ortopedia facial no tratamento de classe III esquelética. As buscas foram realizadas na CENTRAL, MEDLINE, EMBASE, LILACS. Foram incluídos 9 artigos nas análises qualitativa e quantitativa. Foi utilizado modelo de efeito randômico, diferenças de média e intervalo de confiança 95%. Para o posicionamento anteroposterior da maxila, os resultados foram estatisticamente significativos para os tratamentos com AE (Maxila) + MF ou AE (Maxila e Mandíbula) quando comparados aos controles ERM + MF ou não tratados. Para o posicionamento anteroposterior da mandíbula, não houve diferenças estatisticamente significativas. Para maxila em relação à mandíbula, os resultados demonstraram valores de ANB e Wits favoráveis ao tratamento AE (Maxila e Mandíbula) e AE (Maxila) + MF quando comparados a pacientes não tratados, porém quando comparado com ERM + MF não houve diferença significativa. O tratamento com ancoragem esquelética é efetivo para o tratamento de Classe III esquelética em crianças e adolescentes. Os benefícios com o avanço da maxila podem ser observados com a melhora dos parâmetros cefalométricos e a possibilidade de postergar o tratamento para idade de 10 a 13,5 anos. Novos ensaios clínicos randomizados devem ser realizados com o objetivo de aumentar o grau de clareza na tomada das decisões clínicas, assim como mais trabalhos para comparação de outros tipos de tratamento para classe III esquelética. Palavras-chave: Classe III esquelética. Ancoragem esquelética.(AU)

Skeletal class III represents the discrepancy in maxillary and / or mandible bone growth and may be associated with maxillary retrusion, mandibular protrusion or a combination of both conditions. These conditions reflect aesthetic and functional damage to the patient. Recently, skeletal anchorage has been devised as an alternative in the early treatment of class III. This technique aims to correct the bone discrepancy, minimize the adverse effects of the face mask and eliminate the extraoral apparatus. The objective of this study was to evaluate the effectiveness of skeletal anchorage compared to facial orthopedics in skeletal class III treatment. Searches were performed at CENTRAL, MEDLINE, EMBASE, LILACS. Nine articles were included in the qualitative and quantitative analyzes. A random effect model, mean differences and 95% confidence interval were used. For anteroposterior positioning of the maxilla, the results were statistically significant for treatments with AE (Maxilla) + MF or AE (Maxilla and Mandible) when compared to ERM + MF or untreated controls. For anteroposterior positioning of the mandible, there were no statistically significant differences. For maxilla in relation to the mandible, the results showed favorable ANB and Wits values for treatment AE (Maxilla and Mandible) and AE (Maxilla) + MF when compared to untreated patients, but when compared with ERM + MF there was no significant difference. Skeletal anchorage treatment is effective for the treatment of skeletal Class III in children and adolescents. The benefits of maxillary advancement can be seen with improved cephalometric parameters and the possibility of postponing treatment to ages 10 to 13.5 years. Further randomized clinical trials should be conducted to increase clarity in clinical decision making, as well as further work to compare other types of skeletal class III treatment(AU)

Diagnostic validity of different cephalometric analyses for assessment of the sagittal skeletal pattern.

INTRODUCTION: Numerous cephalometric analyses have been proposed to diagnose the sagittal discrepancy of the craniofacial structures. OBJECTIVE: This study aimed at evaluating the reliability and validity of different skeletal analyses for the identification of sagittal skeletal pattern. METHODS: A total of 146 subjects (males = 77; females = 69; mean age = 23.6 ± 4.6 years) were included. The ANB angle, Wits appraisal, Beta angle, AB plane angle, Downs angle of convexity and W angle were used to assess the anteroposterior skeletal pattern on lateral cephalograms. The sample was classified into Class I, II and III groups as determined by the diagnostic results of majority of the parameters. The validity and reliability of the aforementioned analyses were determined using Kappa statistics, sensitivity and positive predictive value (PPV). RESULTS: A substantial agreement was present between ANB angle and the diagnosis made by the final group (k = 0.802). In the Class I group, Downs angle of convexity showed the highest sensitivity (0.968), whereas ANB showed the highest PPV (0.910). In the Class II group, ANB angle showed the highest sensitivity (0.928) and PPV (0.951). In the Class III group, the ANB angle, the Wits appraisal and the Beta angle showed the highest sensitivity (0.902), whereas the Downs angle of convexity and the ANB angle showed the highest PPV (1.00). CONCLUSION: The ANB angle was found to be the most valid and reliable indicator in all sagittal groups. Downs angle of convexity, Wits appraisal and Beta angle may be used as valid indicators to assess the Class III sagittal pattern.

Diagnostic validity of different cephalometric analyses for assessment of the sagittal skeletal pattern

Abstract Introduction: Numerous cephalometric analyses have been proposed to diagnose the sagittal discrepancy of the craniofacial structures. Objective: This study aimed at evaluating the reliability and validity of different skeletal analyses for the identification of sagittal skeletal pattern. Methods: A total of 146 subjects (males = 77; females = 69; mean age = 23.6 ± 4.6 years) were included. The ANB angle, Wits appraisal, Beta angle, AB plane angle, Downs angle of convexity and W angle were used to assess the anteroposterior skeletal pattern on lateral cephalograms. The sample was classified into Class I, II and III groups as determined by the diagnostic results of majority of the parameters. The validity and reliability of the aforementioned analyses were determined using Kappa statistics, sensitivity and positive predictive value (PPV). Results: A substantial agreement was present between ANB angle and the diagnosis made by the final group (k = 0.802). In the Class I group, Downs angle of convexity showed the highest sensitivity (0.968), whereas ANB showed the highest PPV (0.910). In the Class II group, ANB angle showed the highest sensitivity (0.928) and PPV (0.951). In the Class III group, the ANB angle, the Wits appraisal and the Beta angle showed the highest sensitivity (0.902), whereas the Downs angle of convexity and the ANB angle showed the highest PPV (1.00). Conclusion: The ANB angle was found to be the most valid and reliable indicator in all sagittal groups. Downs angle of convexity, Wits appraisal and Beta angle may be used as valid indicators to assess the Class III sagittal pattern.

Resumo Introdução: numerosas análises cefalométricas foram propostas para diagnosticar a discrepância sagital das estruturas craniofaciais. Objetivo: este estudo teve como objetivo avaliar a confiabilidade e validade de diferentes análises esqueléticas para a identificação do padrão esquelético sagital. Métodos: foram incluídos 146 indivíduos (homens = 77; mulheres = 69; idade média = 23,6 ± 4,6 anos). O ângulo ANB, a avaliação de Wits, o ângulo Beta, o ângulo do plano AB, o ângulo de convexidade de Downs e o ângulo W foram utilizados para avaliar o padrão esquelético anteroposterior em cefalogramas laterais. A amostra foi classificada nos grupos Classe I, II e III, conforme os resultados diagnósticos da maioria dos parâmetros. A validade e a confiabilidade das análises acima mencionadas foram determinadas usando estatísticas Kappa, sensibilidade e valor preditivo positivo (VPP). Resultados: foi encontrada uma concordância significativa entre o ângulo ANB e o diagnóstico feito pelo grupo final (k = 0,802). No grupo Classe I, o ângulo de convexidade de Downs mostrou a maior sensibilidade (0,968), enquanto o ANB apresentou o maior VPP (0,910). No grupo Classe II, o ângulo ANB mostrou a maior sensibilidade (0,928) e o maior VPP (0,951). No grupo Classe III, o ângulo ANB, a avaliação de Wits e o ângulo Beta apresentaram a maior sensibilidade (0,902), enquanto o ângulo de convexidade de Downs e o ângulo ANB apresentaram o maior VPP (1,00). Conclusão: o ângulo ANB foi considerado o indicador mais válido e confiável em todos os grupos sagitais. O ângulo de convexidade de Downs, a avaliação de Wits e o ângulo Beta podem ser usados como indicadores válidos para avaliar o padrão sagital de Classe III.