Abstract: This study evaluated the stress distribution in the dentoalveolar and palatal bone structures during maxillary expansion in a 17-year-old male patient with bilateral cleft lip and palate (BCLP) using expanders with dental (HYRAX) and skeletal anchorage (MARPE). For the generation of the specific finite element models, cone-beam computed tomography was used, and the DICOM files were exported to Mimics 3-Matic (Materialise) and Patran (MSC Software) software. Three specific three-dimensional models were generated: A) HYRAX: conventional four-banded hyrax screw (9 mm); B) MARPE-DS: 3 miniscrews (1.8 mm diameter – 5.4 mm length) and four-banded dental anchorage; and C) MARPE-NoDS: 3 miniscrews without dental anchorage. Maxillary expansion was simulated by activating the expanders transversely 1 mm on the "X" axis. HYRAX resulted in higher levels of deformation predominantly in the dentoalveolar region. MARPE-DS showed stress in the dentoalveolar region and mainly in the center of the palatal region, at approximately 4,000 με. MARPE-NoDS exhibited evident stress only in the palatal region. High stress levels in the root anchoring teeth were observed for HYRAX and MARPE-DS. In contrast, MARPE-NoDS cause stress on the tooth structure. The stress distribution from the expanders used in the BLCP showed asymmetric expansive behavior. During the initial activation phase of expansion, the HYRAX and MARPE-DS models produced similarly high strain at the dentoalveolar structures and upper posterior teeth displacement. The MARPE-NoDS model showed restricted strain on the palate. Abstract 17yearold yearold 17 year old BCLP (BCLP (HYRAX MARPE. MARPE . (MARPE) conebeam cone beam 3Matic Matic Materialise (Materialise MSC Software software threedimensional three dimensional generated A fourbanded four banded 9 ( mm) B MARPEDS DS 1.8 18 8 (1. 54 5 4 5. length C MARPENoDS NoDS X "X axis 4000 000 4,00 με MARPEDS. DS. contrast structure behavior displacement (MARPE 1. (1 400 00 4,0 40 0 4,

RESUMO Este artigo relata o caso clínico de uma paciente do sexo feminino, com história de insucessos em tratamentos ortodônticos pregressos. Apresentava má oclusão de Classe III, com atresia de ambas as arcadas dentárias, mordida cruzada anterior e assimetria facial, proveniente de laterognatismo desencadeado por uma hiperatividade condilar, manifestada pelo alongamento vertical do ramo mandibular direito. Seu tratamento envolveu a mecanoterapia ortodôntica e duas intervenções cirúrgicas ortognáticas, com resultados considerados satisfatórios e estáveis. Esse caso foi apresentado à Diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO), como parte dos requisitos para a obtenção do título de Diplomado pelo BBO.

ABSTRACT This article reports the clinical case of a female patient with history of unsuccessful orthodontic treatment. She presented with Class III malocclusion, mandibular and maxillary constriction, anterior crossbite and facial asymmetry resulting from laterognathism triggered by hyperactivity of the condyle revealed by vertical elongation of the right mandibular ramus. Patient's treatment consisted of orthodontic mechanics and two orthognathic surgical interventions with satisfactory and stable outcomes. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO), as part of the requirements for obtaining the BBO Diplomate title.

To evaluate the association between temporomandibular disorder (TMD) and anxiety, quality of sleep, and quality of life in nursing professionals at theHospital de Clínicas de Uberlândiaof theUniversidade Federal de Uberlândia – HCU-UFU (Medical University Hospital of the Federal University of Uberlândia), four questionnaires were given to nursing professionals. The questionnaires were completed by 160 of these professionals. The Fonseca’s questionnaire was used to evaluate the presence and severity of TMD, the IDATE was used to evaluate anxiety, the SAQ was used to evaluate quality of sleep, and the SF-36 was used to evaluate quality of life. Forty-one nurses (25.6%) reported having no TMD (Fonseca’s questionnaire score ≤ 15), 66 (41.3%) had mild TMD (Fonseca’s questionnaire score 20–40), 39 (24.4%) had moderate TMD (Fonseca’s questionnaire score 45–65), and 14 (8.8%) had severe TMD (Fonseca’s questionnaire score ≥ 70). According to Fonseca’s questionnaire, the presence of TMD was associated with trait anxiety, but the TMD severity was associated with state anxiety classification (mild, moderate, severe). The SAQ score differed significantly from Fonseca classification. The Fonseca’s questionnaire score correlated negatively with the score of each dimension of the SF-36 (r = –0.419 to –0.183). We conclude that TMD is common among nursing professionals; its presence was associated with trait anxiety, and its severity was associated with state anxiety. Hence, the presence of TMD may reduce quality of sleep and quality of life.

O objetivo deste estudo foi avaliar a capacidade de identificação de prematuridades oclusais por meio de imagens obtidas de cortes paraxiais de tomografias computadorizadas de feixe cônico. Para este fim, realizou-se um estudo piloto em que 16 pacientes jovens assintomáticos foram submetidos ao exame clínico, incluindo análise oclusal criteriosa, e em seguida foram confeccionados dispositivos desprogramadores individuais (“JIG de Lucia”). Mediante manipulação mandibular e marcação interoclusal com papel carbono (Accufilm) identificou-se clinicamente o contato prematuro em relação cêntrica (RC) de cada paciente. Posteriormente estes dispositivos foram ajustados na posição de contato cêntrico e utilizados durante os exames tomográficos para que se pudessem obter imagens tomográficas na posição de relação cêntrica. Após o processamento das imagens, estas foram analisadas com o intuito de identificar prematuridades oclusais nas imagens visualizadas por 30 profissionais divididos de acordo com as áreas de atuação (Oclusão, Clínica Geral e Radiologia, n=10 para cada área) e tempo de exercício profissional (<5; entre 5 e 10; e >10 anos). Mediante comparação entre os contatos prematuros identificados na análise clínica oclusal e as imagens tomográficas apontadas pelos profissionais como áreas de contatos prematuros, foram calculados os índices de concordância entre essas duas variáveis. Os dados obtidos foram analisados estatisticamente pela Análise de Variância ANOVA e teste de Scott-Knott (α=0,05). Os resultados deste estudo demonstraram que a identificação de prematuridades oclusais por meio de cortes paraxiais de tomografias computadorizadas de feixe cônico mostrou-se como um método de confiabilidade média.

The aim of this study was to evaluate the ability to identify occlusal prematurity by images from paraxial slices of cone-beam computed tomography (CBCT). For such purpose, a pilot study was performed in which 16 asymptomatic young patients were subjected to a clinical examination, including a careful occlusal analysis and then individual deprogrammer devices (“Lucia's JIG”) were fabricated. Premature contacts were clinically identified in centric relation (CR) for each patient by jaw manipulation and interocclusal marking with articulating paper (Accufilm). Subsequently, these devices were adjusted in CR and used during the tomographic exams in such a way that CBCT in CR could be obtained. After routine processing, the images were analyzed in order to identify occlusal prematurity on the displayed images by 30 professionals divided according to areas of activity (occlusion specialist, general practitioner and radiologist; n=10 per area) and time of professional experience (less than 5, between 5 and 10, and over 10 years). By comparing the premature contacts identified in the clinical analysis and CBCT images, an agreement index between these two variables was calculated. Data were analyzed statistically by ANOVA and Scott-Knott test (α=0.05). The results showed that the identification of occlusal prematurity by paraxial CBCT slices was proven to be a method of average reliability.

OBJECTIVE: This study aimed to establish cephalometric reference values for mandibular symphysis in adults. Dentoalveolar, skeletal and soft tissue variables were measured considering the influence of gender and facial type. METHODS: The sample consisted of sixty cephalometric radiographs of white Brazilian adult patients, with a mean age of 27 years and 6 months, who had not undergone orthodontic treatment and who presented well-balanced faces and normal occlusion. The sample was standardized according to gender (30 males and 30 females) and facial type (20 were dolichofacial, 20 mesofacial and 20 brachyfacial). RESULTS: The results showed that male and female symphyses are similar, except for symphyseal height, which was greater in males. In terms of facial type, the dolichofacial group presented narrower symphysis in dentoalveolar and basal areas, with a more accentuated lingual dentoalveolar inclination. CONCLUSION: The brachyfacial group showed broader symphysis in the dentoalveolar and basal areas and a greater buccal dentoalveolar inclination. The projection of the chin was 6.67 mm below the subnasal vertical line and there was no significant difference between the genders or facial types.

The magnitude of occasional discrepancies between the centric relation and maximal intercuspation positions remains a controversial subject. This study quantitatively evaluated the possible discrepancies in the condyle/mandibular fossa relationship between these positions using cone-beam computed tomography. Twenty young and asymptomatic volunteers were distributed equally into normal occlusion and Angle Class I, II and III malocclusion groups. They were submitted to one tomographic scan in maximal intercuspation and one in centric relation. Measurements were performed on lateral and frontal cuts of the patients' temporomandibular joints, and the data collected were compared using Student's t test at a significance level of 5%. The results showed that there were no statistically significant differences between the centric relation and maximal intercuspation positions in young and asymptomatic patients with practically intact dentitions using cone-beam computed tomography.