Craniofacial characteristics of Caucasian and Afro-Caucasian Brazilian subjects with normal occlusion

OBJECTIVE: The objective of this study was to compare the skeletal, dental and soft tissue characteristics of Caucasian and Afro-Caucasian Brazilian subjects with normal occlusion and to evaluate sexual dimorphism within the groups. MATERIAL AND METHODS: The sample comprised lateral cephalograms of untreated normal occlusion subjects, divided into 2 groups. Group 1 included 40 Caucasian subjects (20 of each sex), with a mean age of 13.02 years; group 2 included 40 Afro-Caucasian subjects (20 of each sex), with a mean age of 13.02 years. Groups 1 and 2 and males and females within each group were compared with t tests. RESULTS: Afro-Caucasian subjects presented greater maxillary protrusion, smaller upper anterior face height and lower posterior face height, larger upper posterior face height, greater maxillary and mandibular dentoalveolar protrusion as well as soft tissue protrusion than Caucasian subjects. The Afro-Caucasian female subjects had less mandibular protrusion and smaller total posterior facial height and upper posterior facial height than males. CONCLUSIONS: Brazilian Afro-Caucasian subjects have greater dentoalveolar and soft tissue protrusion than Brazilian Caucasian subjects, with slight sexual dimorphism in some variables.

Maxillary protraction after surgically assisted maxillary expansion

This case report describes the orthodontic treatment of a 32-year-old woman with a Class III malocclusion, whose chief compliant was her dentofacial esthetics. The pretreatment lateral cephalometric tracings showed the presence of a Class III dentoskeletal malocclusion with components of maxillary deficiency. After discussion with the patient, the treatment option included surgically assisted rapid maxillary expansion (SARME) followed by orthopedic protraction (Sky Hook) and Class III elastics. Patient compliance was excellent and satisfactory dentofacial esthetics was achieved after treatment completion.

Segmental LeFort I osteotomy for treatment of a class III malocclusion with temporomandibular disorder

This article reports the case of a 19-year-old young man with Class III malocclusion and posterior crossbite with concerns about temporomandibular disorder (TMD), esthetics and functional problems. Surgical-orthodontic treatment was carried out by decompensation of the mandibular incisors and segmentation of the maxilla in 4 pieces, which allowed expansion and advancement. Remission of the signs and symptoms occurred after surgical-orthodontic intervention. The maxillary dental arch presented normal transverse dimension. Satisfactory static and functional occlusion and esthetic results were achieved and remained stable. Three years after the surgical-orthodontic treatment, no TMD sign or symptom was observed and the occlusal results had not changed. When vertical or horizontal movements of the maxilla in the presence of moderate maxillary constriction are necessary, segmental LeFort I osteotomy can be an important part of treatment planning.

Reprodutibilidade das mensurações da espessura das tábuas ósseas na tomografia computadorizada Cone-Beam utilizando diferentes protocolos de aquisição de imagem

INTRODUÇÃO: quanto menor a dimensão do voxel, maior a nitidez da imagem de tomografia computadorizada Cone-Beam (TCCB), porém, maior a dose de radiação emitida. OBJETIVOS: avaliar e comparar a reprodutibilidade da mensuração da espessura das tábuas ósseas vestibular e lingual em imagens de TCCB, utilizando diferentes protocolos de aquisição de imagem com variação da dimensão do voxel. MÉTODOS: exames de TCCB foram tomados de 12 mandíbulas humanas secas, com dimensão do voxel de 0,2; 0,3 e 0,4mm, no aparelho i-CAT Cone-Beam 3-D Dental Imaging System. No software i-CAT Viewer, foi mensurada a espessura das tábuas ósseas vestibular e lingual, em um corte axial passando 12mm acima do forame mentoniano do lado direito. A reprodutibilidade intraexaminador foi avaliada por meio da aplicação do teste t pareado. Para a comparação interexaminadores, foi utilizado o teste t independente. Os resultados foram considerados com o nível de significância de 5%. RESULTADOS: observou-se uma excelente reprodutibilidade interexaminadores para os três protocolos avaliados. A reprodutibilidade intraexaminadores foi muito boa, com exceção de algumas regiões dos dentes anteriores, que mostraram diferenças estatisticamente significativas, independentemente da dimensão do voxel. CONCLUSÃO: a mensuração da espessura das tábuas ósseas vestibular e lingual em imagens de TCCB mostrou boa precisão para exames obtidos com voxel de 0,2; 0,3 ou 0,4mm. A reprodutibilidade das mensurações na região anterior da mandíbula foi mais crítica do que na região posterior.

Comparison of periodontal parameters in individuals with syndromic craniosynostosis

Craniosynostosis syndromes are characterized by premature closure of one or more cranial sutures, associated with other malformations, the most frequent of which are the Crouzon and Apert syndromes. Few studies in the literature have addressed the oral health of these individuals. The purpose of this study was to compare the periodontal status of individuals with Apert, Crouzon, Pfeiffer and Saethre-Chotzen syndromes before toothbrushing and compare the efficiency of plaque removal before and after mechanical toothbrushing. The probing depth, plaque index (according to Löe and O'Leary), clinical attachment level, gingival index (according to Silness and Löe) and amount of keratinized mucosa were evaluated before toothbrushing, and the O'Leary plaque index was assessed before and immediately after toothbrushing, on the same day, in 27 individuals aged 11 to 36 years. There was statistically significant difference in the mean probing depth and clinical attachment level among regions (p=0.00; p=0.01, respectively). The gingival index did not reveal statistically significant differences. With regard to the plaque index, the left region exhibited higher plaque index values than the right and anterior regions. No significant results were found in the analysis of keratinized mucosa. Comparison of the O'Leary plaque index before and after toothbrushing revealed statistically significant difference for all syndromes except for the Pfeiffer syndrome (p<0.05). In conclusion, there was no difference in the periodontal status among individuals with syndromic craniosynostosis. The posterior region was more affected than the anterior region as to the presence of plaque, loss of insertion and probing depth. Individuals with Pfeiffer syndrome exhibited greater toothbrushing efficiency than individuals with the other craniosynostosis syndromes.

Effect of experimental chewing on masticatory muscle pain onset

OBJECTIVES: To evaluate the effect of a chewing exercise on pain intensity and pressure-pain threshold in patients with myofascial pain. METHODS: Twenty-nine consecutive women diagnosed with myofascial pain (MFP) according to the Research Diagnostic Criteria comprised the experimental group and 15 healthy age-matched female were used as controls. Subjects were asked to chew a gum stick for 9 min and to stay at rest for another 9 min afterwards. Pain intensity was rated on a visual analog scale (VAS) every 3 min. At 0, 9 and 18 min, the pressure-pain threshold (PPT) was measured bilaterally on the masseter and the anterior, medium, and posterior temporalis muscles. RESULTS: Patients with myofascial pain reported increase (76%) and no change (24%) on the pain intensity measured with the VAS. A reduction of the PPT at all muscular sites after the exercise and a non-significant recovery after rest were also observed. CONCLUSION: The following conclusions can be drawn: 1. there are at least two subtypes of patients with myofascial pain that respond differently to experimental chewing; 2. the chewing protocol had an adequate discriminative ability in distinguishing patients with myofascial pain from healthy controls.

Rehabilitation of severely resorbed edentulous mandible using the modified visor osteotomy technique

The prosthetic rehabilitation of an atrophic mandible is usually unsatisfactory due to the lack of support tissues, mainly bone and keratinized mucosa for treatment with osseointegrated implants or even conventional prosthesis. The prosthetic instability leads to social and functional limitations and chronic physical trauma decreasing the patient's quality of life. A 53-year-old female patient sought care at our surgical service complaining of impairment of her masticatory function associated with the instability of the lower total prosthetic denture. The clinical and complementary exams revealed edentulism in both arches, while the mandibular arch presented severe reabsorption resulting in denture instability and chronic trauma to the oral mucosa. The proposed treatment plan consisted in the mandibular rehabilitation with osseointegrated implants and fixed Brånemark's protocol prosthesis after mandibular reconstruction applying the modified visor osteotomy technique. The proposed technique offered predictable results for reconstruction of the severely resorbed edentulous mandible and posterior rehabilitation with osseointegrated implants.

Avaliação cefalométrica das alterações verticais e anteroposteriores associadas ao uso do expansor maxilar com cobertura oclusal

INTRODUÇÃO: os aparelhos expansores maxilares com cobertura oclusal têm sido sugeridos para controlar o aumento na dimensão vertical da face após a expansão rápida da maxila, porém ainda não há um consenso na literatura sobre seus reais efeitos. OBJETIVO: o objetivo deste trabalho foi avaliar as alterações cefalométricas verticais e anteroposteriores associadas à expansão da maxila realizada com o aparelho expansor com cobertura oclusal. MÉTODOS: a amostra foi composta por 25 crianças, de ambos os gêneros, com idades entre 6 e 10 anos, portadoras de mordida cruzada posterior esquelética. Após a expansão maxilar, o próprio aparelho expansor foi utilizado como contenção fixa. Foram analisadas telerradiografias em norma lateral tomadas antes do início do tratamento e após a remoção do aparelho expansor. CONCLUSÃO: com base nos resultados, pôde-se concluir que o uso do aparelho expansor com cobertura oclusal não alterou significativamente as medidas cefalométricas verticais e anteroposteriores das crianças.

Dimensões nasofaringeanas e faciais em diferentes padrões morfológicos

OBJETIVO: o presente estudo propõe-se a comparar as dimensões da nasofaringe e as características esqueléticas avaliadas por exame cefalométrico, em indivíduos com padrões morfológicos distintos. MÉTODOS: foram utilizadas 90 telerradiografias de pacientes de ambos os gêneros, de 12 a 16 anos de idade, as quais foram igualmente divididas em três grupos distintos, referentes aos padrões morfológicos - braquifacial, mesofacial e dolicofacial. Foram realizadas medições específicas da região nasofaringeana (ad1-Ptm, ad2-Ptm, ad1-Ba, ad2-S0, (ad1-ad2-S0-Ba-ad1/Ptm-S 0-Ba-Ptm) X 100, e Ptm-Ba) e relativas ao padrão esquelético da face. RESULTADOS: observou-se que os pacientes dolicofaciais apresentaram menor profundidade sagital óssea (Ptm-Ba) e da via aérea da nasofaringe (ad1-Ptm e ad2-Ptm). Sugere-se que essas diferenças estejam relacionadas a um posicionamento relativamente mais posterior da maxila, comum a esses pacientes. Todavia, não foram detectadas diferenças quanto à espessura de tecido mole na parede posterior nasofaringeana (ad1-Ba e ad2-S0), ou à sua proporção em relação a toda a área delimitada para a nasofaringe [(ad1-ad2-S0-Ba-ad1/Ptm-S 0-Ba-Ptm) X 100]. CONCLUSÃO: sugere-se, portanto, que as características faciais de excesso vertical encontradas em pacientes dolicofaciais podem ocorrer, dentre outros fatores, em virtude da obstrução da via aérea nasofaringeana, uma vez que tais dimensões se apresentaram menores para os dolicofaciais.

Skeletal alterations associated with the use of bonded rapid maxillary expansion appliance

Bonded maxillary expansion appliances have been suggested to control increases in the vertical dimension of the face after rapid maxillary expansion (RME). However, there is still no consensus in the literature about its real skeletal effects. The purpose of this prospective study was to evaluate, longitudinally, the vertical and sagittal cephalometric alterations after RME performed with bonded maxillary expansion appliance. The sample consisted of 26 children, with a mean age of 8.7 years (range: 6.9-10.9 years), with posterior skeletal crossbite and indication for RME. After maxillary expansion, the bonded appliance was used as a fixed retention for 3.4 months, being replaced by a removable retention subsequently. The cephalometric study was performed onto lateral radiographs, taken before treatment was started, and again 6.3 months after removing the bonded appliance. Intra-group comparison was made using paired t test. The results showed that there were no significant sagittal skeletal changes at the end of treatment. There was a small vertical skeletal increase in five of the eleven evaluated cephalometric measures. The maxilla displaced downward, but it did not modify the facial growth patterns or the direction of the mandible growth. Under the specific conditions of this research, it may be concluded that RME with acrylic bonded maxillary expansion appliance did promote signifciant vertical or sagittal cephalometric alterations. The vertical changes found with the use of the bonded appliance were small and probably transitory, similar to those occurred with the use of banded expansion appliances.

Orthodontic-surgical treatment of class III malocclusion with mandibular asymmetry

Class III skeletal malocclusion may present several etiologies, among which maxillary deficiency is the most frequent. Bone discrepancy may have an unfavorable impact on esthetics, which is frequently aggravated by the presence of accentuated facial asymmetries. This type of malocclusion is usually treated with association of Orthodontics and orthognathic surgery for correction of occlusion and facial esthetics. This report presents the treatment of a patient aged 15 years and 1 month with Class III skeletal malocclusion, having narrow maxilla, posterior open bite on the left side, anterior crossbite and unilateral posterior crossbite, accentuated negative dentoalveolar discrepancy in the maxillary arch, and maxillary and mandibular midline shift. Clinical examination also revealed maxillary hypoplasia, increased lower one third of the face, concave bone and facial profiles and facial asymmetry with mandibular deviation to the left side. The treatment was performed in three phases: presurgical orthodontic preparation, orthognathic surgery and orthodontic finishing. In reviewing the patient's final records, the major goals set at the beginning of treatment were successfully achieved, providing the patient with adequate masticatory function and pleasant facial esthetics.

Visibility of the mandibular canal on CBCT crosssectional images

The identification of the mandibular canal (MC) is an important prerequisite for surgical procedures involving the posterior mandible. Cone beam computed tomography (CBCT) represents an advance in imaging technology, but distinguishing the MC from surrounding structures may remain a delicate task. OBJECTIVES: The aim of this study was to assess the visibility of the MC in different regions on CBCT cross-sectional images. MATERIAL AND METHODS: CBCT cross-sectional images of 58 patients (116 hemi-mandibles) were analyzed, and the visibility of the MC in different regions was assessed. RESULTS: The MC was clearly visible in 53% of the hemi-mandibles. Difficult and very difficult visualizations were registered in 25% and 22% of the hemi-mandibles, respectively. The visibility of the MC on distal regions was superior when compared to regions closer to the mental foramen. No differences were found between edentulous and tooth-bearing areas. CONCLUSIONS: The MC presents an overall satisfactory visibility on CBCT cross-sectional images in most cases. However, the discrimination of the canal from its surrounds becomes less obvious towards the mental foramen region when cross-sectional images are individually analyzed.

Endodontic treatment of dental formation anomalies

PURPOSE: Dental fusion is defined as the union of two dental germs at some stage of their development. The aim of this article is to report the endodontic treatment of two clinical cases of dental fusion. CASE DESCRIPTION: In the first case, the patient was referred by an orthodontist for endodontic treatment of tooth 12, which was fused to 13. Surgical separation and later replacement of the involved elements in the dental arch was indicated. In the second case, the patient sought dental attendance due to spontaneous pain. In the radiographic exam, gemination in tooth 11 and fusion of 21 with a supernumerary tooth was observed. The fused teeth were endodontically treated, and patients were referred to other dental specialties to reestablish esthetics and function. CONCLUSION: The dentist must be able to diagnose, differentiate and treat these dental anomalies adequately, with the goal of maintaining patients' oral health.

Measurements of jaw movements and TMJ pain intensity in patients treated with GaAlAs laser

The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) on the improvement of the mandibular movements and painful symptoms in individuals with temporomandibular disorders (TMD). Forty patients were randomly divided into two groups (n=20): Group 1 received the effective dose (GaAlAs laser ? 830 nm, 40 mW, 5J/cm2) and Group 2 received the placebo application (0 J/cm2), in continuous mode on the affected condyle lateral pole: superior, anterior, posterior, and posterior-inferior, twice a week during 4 weeks. Four evaluations were performed: E1 (before laser application), E2 (right after the last application), E3 (one week after the last application) and E4 (30 days after the last application). The Kruskal-Wallis test showed significant more improvements (p<0.01) in painful symptoms in the treated group than in the placebo group. A significant improvement in the range of mandibular movements was observed when the results were compared between the groups at E4. Laser application can be a supportive therapy in the treatment of TMD, since it resulted in the immediate decrease of painful symptoms and increased range of mandibular movements in the treated group. The same results were not observed in the placebo group.

Prevalence of malocclusions in the 13-20-year-old categories of football athletes

The dentist can offer athletes improvement in their physical performance through the maintenance of oral health, preventing and treating any and all changes in the stomatognathic system, such as dental malocclusions, that compromise the athletes' performance. The objective of this study is to research the presence of dental malocclusions in athletes of the category between 13 and 20 years of age, from the São Paulo Football Club. 84 athletes participated in this study, dealing with the following topics: molar relation (Angle's classification); presence of overbite; underbite; overcrowding; abnormal spacing; open bite; and anterior, posterior, bilateral and unilateral crossbite; midline deviation and facial type (mesofacial, brachyfacial and dolichofacial). Only one table was made, showing percentages. In regard to Angle's molar relation, 89% are in Class I, 8% in Class II, 3% Class III, 9% of the athletes had overbite, 4% had underbite, 13% had overcrowding and 21% had abnormal spacing. In regard to the bite, 11% presented anterior open bite. In regard to crossbite, 7% presented unilateral crossbite on the right side and 2% on the left side; 5% presented posterior crossbite and 4% anterior crossbite. In regard to midline deviations, 4% presented deviation in the maxilla and 33% in the mandible. In regard to facial type: 39% are dolichofacial, 4% brachyfacial and 57% mesofacial. Based on the results shown, proposals for the implementation of dental, phoniatric, and Ear, Nose and Throat (ENT) practices are already being discussed with the multidisciplinary team of the club involved.