Abstract The object of this study was to compare the clinical complications of 4 different appliances used in the early treatment of anterior open bite (AOB), and to test the null hypothesis that there is no difference in the number of complications among the appliances. Records from 99 Class I malocclusion patients with AOB treated using bonded spurs, BS, n = 25; chin cup, CC, n = 25; fixed palatal crib, FPC, n = 25; and removable palatal crib, RPC, n = 24) were examined. The total number and frequency of clinical complications that occurred over 12 months were described and compared by using chi-square and Kruskal-Wallis tests (Dunn’s post-test) (α = 5%, CI = 95%). The incidence of clinical complications was 66.7%, comprising: breakage, bond failure, maladjustment, allergy, soft-tissue lesion, loss of removable appliance and abandonment. Eighteen patients gave up treatment; this occurred more frequently in the groups with removable appliances. Regarding the total number of complications per patient, Group BS exhibited a significantly higher number than the other groups (p < 0.0001). A low frequency of complications (1 to 3) was found in the groups, except for Group BS, in which 8% of the patients presented moderate frequency (4 to 6). In terms of appliance types (fixed or removable), there was no difference in the incidence of complications (p > 0.094). The null hypothesis was rejected, since the BS group exhibited the highest total number and frequency of complications. There was no difference between fixed and removable appliances in terms of incidence of clinical complications, although more patients using removable appliances abandoned their treatment.
ABSTRACT Objective: This prospective study aimed at assessing the effects of anxiety and a follow-up text message on pain perception after the installation of fixed orthodontic appliances and its impact on the patients’ routine. Methods: The sample of this study consisted of 103 orthodontic patients, 40 males and 63 females (mean age 20.5 years), distributed in two groups: G1 (n=51), including control patients that did not receive any post-procedure communication; and G2 (n=52), including patients that received a structured text message. In baseline phase, the patients completed a questionnaire to assess their level of anxiety prior to treatment. Pain was assessed by using 100-mm visual analog scale (VAS) in baseline and ten times prospectively in predetermined time points. VAS was also applied to assess the patient’s routine alterations caused by the pain. All data were analyzed using ANOVA, Tukey, Mann-Whitney, t-test, chi-square and Spearman’s correlation tests. All statistical tests were performed with significance level of 5%. Results: Low-level and high-level anxiety was observed in 42.7% and 7.8% of the patients, respectively. Statistically significant correlation was observed between anxiety and pain (p< 0.05). Maximum mean pain intensity was detected in the second treatment day (G1=36.9mm and G2=26.2mm) and was significantly higher in G1. Nearly 53% of the patients in G1 reported alterations in the routine (18.8mm), while in G2 the percentage rate reached 28.8% (9.9mm) (p=0.013). Conclusions: Anxious patients report more pain after the installation of orthodontic appliances. Text messages were effective to reduce pain levels and to decrease the negative effects on patients’ daily routine.
RESUMO Objetivo: O presente estudo prospectivo teve como objetivo avaliar os efeitos da ansiedade e de mensagens de texto de acompanhamento na percepção da dor após a instalação de aparelhos ortodônticos fixos e seu impacto na rotina dos pacientes. Métodos: A amostra deste estudo foi composta por 103 pacientes ortodônticos, 40 homens e 63 mulheres (idade média de 20,5 anos), distribuídos em dois grupos: G1 (n = 51), que incluiu pacientes controle, que não receberam comunicação pós-procedimento; e G2 (n = 52), incluindo os pacientes que receberam mensagem de texto estruturada. Na fase inicial, os pacientes responderam a um questionário para avaliar seu nível de ansiedade antes do tratamento. A dor foi avaliada por meio de escala visual analógica (EVA) de 100 mm antes da instalação dos aparelhos e em 10 períodos consecutivos predeterminados. A EVA também foi aplicada para avaliar as alterações de rotina do paciente causadas pela dor. Os resultados foram analisados usando ANOVA, Tukey, Mann-Whitney, teste t, Qui-quadrado e testes de correlação de Spearman. Todos os testes estatísticos foram realizados com nível de significância de 5%. Resultados: Níveis baixos e altos de ansiedade foram observados em 42,7% e 7,8% dos pacientes, respectivamente. Foi observada correlação estatisticamente significativa entre ansiedade e dor (p< 0,05). A intensidade média máxima da dor foi detectada no segundo dia de tratamento (G1 = 36,9mm e G2 = 26,2mm) e foi significativamente maior no G1. Quase 53% dos pacientes do G1 relataram alterações na rotina (18,8mm), enquanto no G2 o percentual atingiu 28,8% (9,9mm) (p= 0,013). Conclusões: Pacientes ansiosos relatam mais dor após a instalação de aparelhos ortodônticos. As mensagens de texto foram eficazes para reduzir os níveis de dor e diminuir os efeitos negativos na rotina diária dos pacientes.
Abstract Objective The aim of this retrospective study was to evaluate the long-term effects of orthodontic traction on root length and alveolar bone level in impacted canines and adjacent teeth. Material and Methods Sample consisted of 16 patients (nine males and seven females), mean initial age 11 years and 8 months presenting with unilaterally maxillary impacted canines, palatally displaced, treated with the same surgical and orthodontic approach. Teeth from the impacted-canine side were assigned as Group I (GI), and contralateral teeth as control, Group II (GII). The mean age of patients at the end of orthodontic treatment was 14 years and 2 months and the mean post-treatment time was 5 years and 11 months. Both contralateral erupted maxillary canines and adjacent teeth served as control. Root length and alveolar bone level (buccal and palatal) were evaluated on cone-beam computed tomography (CBCT) images. The comparison of root length and alveolar bone level changes between groups were assessed by applying paired t-test, at a significance level of 5% (p<0.05). Results There were no statistically significant differences in root length and buccal and palatal bone levels of canines and adjacent teeth among groups. Conclusions Impacted canine treatment by closed-eruption technique associated with canine crown perforation, has a minimal effect on root length and buccal and palatal alveolar bone level in both canine and adjacent teeth, demonstrating that this treatment protocol has a good long-term prognosis.
ABSTRACT Objective: The objective of this study was to evaluate the facial attractiveness in 30 black individuals, according to the Subjective Facial Analysis criteria. Methods: Frontal and profile view photographs of 30 black individuals were evaluated for facial attractiveness and classified as esthetically unpleasant, acceptable, or pleasant by 50 evaluators: the 30 individuals from the sample, 10 orthodontists, and 10 laymen. Besides assessing the facial attractiveness, the evaluators had to identify the structures responsible for the classification as unpleasant and pleasant. Intraexaminer agreement was assessed by using Spearman's correlation, correlation within each category using Kendall concordance coefficient, and correlation between the 3 categories using chi-square test and proportions. Results: Most of the frontal (53. 5%) and profile view (54. 9%) photographs were classified as esthetically acceptable. The structures most identified as esthetically unpleasant were the mouth, lips, and face, in the frontal view; and nose and chin in the profile view. The structures most identified as esthetically pleasant were harmony, face, and mouth, in the frontal view; and harmony and nose in the profile view. The ratings by the examiners in the sample and laymen groups showed statistically significant correlation in both views. The orthodontists agreed with the laymen on the evaluation of the frontal view and disagreed on profile view, especially regarding whether the images were esthetically unpleasant or acceptable. Conclusions: Based on these results, the evaluation of facial attractiveness according to the Subjective Facial Analysis criteria proved to be applicable and to have a subjective influence; therefore, it is suggested that the patient's opinion regarding the facial esthetics should be considered in orthodontic treatmentplanning.
RESUMO Objetivo: avaliar, quanto à agradabilidade facial, uma amostra de 30 indivíduos negros, de acordo com os critérios da Análise Facial Subjetiva. Métodos: fotografias frontais e de perfil de 30 indivíduos negros foram avaliadas quanto à agradabilidade facial e classificadas como esteticamente desagradáveis, aceitáveis ou agradáveis, por 50 avaliadores, sendo: 30 indivíduos da amostra, 10 ortodontistas e 10 leigos. Além de avaliar a agradabilidade facial, os avaliadores tiveram que identificar as estruturas responsáveis pela classificação como desagradável ou agradável. A concordância intraexaminador foi avaliada por meio da correlação de Spearman. Já a correlação dentro de cada categoria foi analisada por meio do coeficiente de concordância de Kendall, e a correlação entre as três categorias foi estabelecida por meio dos testes qui-quadrado e de proporção. Resultados: a maioria das fotografias frontais (53,5%) e de perfil (54,9%) foi classificada como esteticamente aceitável. As estruturas mais identificadas como esteticamente desagradáveis foram: boca, lábios e rosto, na fotografia frontal; e nariz e queixo, na fotografia de perfil. As estruturas mais identificadas como esteticamente agradáveis foram: harmonia, rosto e boca, na fotografia de frente; e harmonia e nariz, na de perfil. As avaliações realizadas pelos examinadores nos grupos amostra e leigos mostraram uma correlação estatisticamente significativa em ambas as posições. Os ortodontistas concordaram com os leigos sobre a avaliação na perspectiva frontal e discordaram sobre a de perfil, especialmente no que diz respeito às imagens consideradas esteticamente desagradáveis ou aceitáveis. Conclusões: com base nesses resultados, a avaliação da agradabilidade facial, de acordo com critérios da Análise Facial Subjetiva, provou ser aplicável e ter uma influência subjetiva. Assim, sugere-se que a opinião do paciente sobre a estética facial seja considerada no planejamento do tratamento ortodôntico.
ABSTRACT Purpose To investigate the influence of the presence of Temporomandibular Disorders (TMD) on postural balance in elderly individuals. Methods The study sample consisted of 150 elderly: 103 women (67.7±5.0 years) and 47 men (69.3±5.5 years). Evaluation of the presence and severity of TMD included an anamnesis questionnaire, an evaluation of the temporomandibular joint (TMJ), and a muscular examination, which allowed the division of the elderly into 2 groups: G1 (experimental, n=95), with TMD; G2 (control, n=55), without TMD. Postural balance was assessed by means of the one-leg stance test (OLST) on a force platform (BIOMEC400), thus permitting the following measurements: center of foot pressure (COP); mean sway velocity (MV) and frequency (MF) of COP in both the anteroposterior (VAP and FAP) and medial/lateral (VML and FML) directions. The statistical analysis of data was performed using independent t-test, Variance Analysis, and Chi Square test (α=5%). Results Presence of TMD was observed in 63.3% of the individuals (Group 2), with different degrees of severity (mild: 42.7%, moderate: 14.7%, severe: 6%). Significantly higher TMD was observed for women (73.8%) compared with men (40.4%) (p=0.0002). No significant difference was found in between the groups for all balance parameters, e.g., presence and severity of TMD, presence of pain to palpation of TMJ and of masticatory and cervical muscles. Conclusion The presence and severity of TMD, in addition to the presence of pain to palpation of TMJ and masticatory and cervical muscles did not alter the variables related to postural balance in this population.
ABSTRACT The relationship between Temporomandibular Disorders (TMD) and malocclusion is an extremely critical issue in dentistry. Contrary to the old concept that malocclusion causes TMD, occlusal changes, especially those observed as sudden, may be secondary and reflect joint or muscle disorders due to the obvious connection between these structures and the dental occlusion. Objectives The aim of this article is to present the most commonly occlusal changes secondary to TMD. Methods The clinical presentation of these conditions is discussed. Details regarding diagnosis, treatment, and follow-up of patients presenting TMD prior or during treatment are also presented. Conclusions All plans for irreversible therapy should be preceded by a meticulous analysis of TMD signs and symptoms in such a way that patients are not submitted to irreversible treatment, based on an untrue occlusal relationship, secondary to articular and/or muscular disorders. When present, TMD symptoms must always be controlled to reestablish a “normal” occlusion and allow proper treatment strategy.
Abstract The aim of this research was to evaluate age-related changes in the smile of Brazilian women. The sample consisted of 249 Brazilian women who had not undergone previous orthodontic treatment or facial surgery. They were divided into four groups, according to age: G1 (20-29), G2 (30-39), G3 (40-49) and G4 (50 or older). Standardized front view photographs were taken while smiling and at rest. Measurements were evaluated by ANOVA and post-hoc Tukey. The Chi-square test was applied for qualitative variables. Upper lip thickness at rest and exposure of upper incisors on smiling decreased with age. Most individuals (60.9%) exhibited a medium smile. High smiles were more often seen in G1 (45%) and less frequently in G4 (18.8%), whereas the opposite occurred with the low smile, i.e., G4 (21.9%) and G1 (6.7%). Variations among the groups were observed in the transverse exposure of the teeth on smiling. In G1 and G3, there was a balance between tooth exposures, so that the teeth were exposed as far as the premolars and/or molars. Most of the women (56.3%) in G2 exposed their teeth as far as the first molars on smiling, whereas most of those (40.6%) in G4 exposed their teeth only as far as the first premolars on smiling. As age increased, there was decreased exposure of the upper incisors, decreased upper lip thickness and lower exposure of teeth vertically and transversely.
Abstract The aim of this study was to investigate condyle concentricity and morphology, and their association with Class I and II malocclusions (Angle). The sample consisted of 49 individuals of both genders, between 11 and 35 years old, divided into two groups, G1: 26 patients with Class I malocclusion, and G2: 23 patients with Class II malocclusion, selected for orthodontic treatment. Evaluation of the condyle morphology and position was performed by the same previously calibrated examiner using cone-beam computed tomography (CBCT) images of the subjects. The CBCT scans were analyzed by means of a 3D program (Dolphin 11.5, Dolphin Imaging & Management Solutions, Chatsworth, CA, USA), with a 25% level of sensitivity. The images obtained from the coronal slices were employed for the condyle morphology analysis, which classified the condyle form as rounded, as flat or convex, and as triangular or angled. The sagittal slices were used to classify further the condyles as concentric and displaced anteriorly or posteriorly. A clinical examination was also performed, including TMJ and muscle palpation. The kappa test was used to evaluate investigator calibration; the Chi-square and paired t-tests were used for analysis. The convex and anteriorly positioned condyles were found most frequently, regardless of the type of malocclusion. No association was observed between the groups regarding condylar characteristics.
OBJECTIVE: The aim of the present study was to compare dentoalveolar changes in mandibular arch, regarding transversal measures and buccal bone thickness, in patients undergoing the initial phase of orthodontic treatment with self-ligating or conventional bracket systems. METHODS: A sample of 25 patients requiring orthodontic treatment was assessed based on the bracket type. Group 1 comprised 13 patients bonded with 0.022-in self-ligating brackets (SLB). Group 2 included 12 patients bonded with 0.022-in conventional brackets (CLB). Cone-beam computed tomography (CBCT) scans and a 3D program (Dolphin) assessed changes in transversal width of buccal bone (TWBB) and buccal bone thickness (BBT) before (T1) and 7 months after treatment onset (T2). Measurements on dental casts were performed using a digital caliper. Differences between and within groups were analyzed by Student's t-test; Pearson correlation coefficient was also calculated. RESULTS: Significant mandibular expansion was observed for both groups; however, no significant differences were found between groups. There was significant decrease in mandibular buccal bone thickness and transversal width of buccal bone in both groups. There was no significant correlation between buccal bone thickness and dental arch expansion. CONCLUSIONS: There were no significant differences between self-ligating brackets and conventional brackets systems regarding mandibular arch expansion and changes in buccal bone thickness or transversal width of buccal bone.
OBJETIVO: o objetivo do presente estudo foi comparar as alterações dentoalveolares transversais e a espessura óssea da arcada inferior em pacientes submetidos ao tratamento ortodôntico utilizando sistemas de braquetes autoligáveis ou convencionais. MÉTODOS: uma amostra de 25 pacientes requerendo tratamento ortodôntico foi recrutada com base no tipo de braquete. No Grupo 1, 13 pacientes foram tratados com braquetes autoligáveis (SLB, slot 0,022"); o Grupo 2 incluiu 12 pacientes, nos quais foram colados braquetes convencionais (CLB, slot 0,022"). Utilizou-se tomografia computadorizada de feixe cônico e um programa 3D (Dolphin) para avaliar as alterações pré-tratamento (T1) e 7 meses após o início desse (T2). As medições em modelos de gesso foram realizadas com o auxílio de um paquímetro digital. As diferenças intergrupos, bem como intragrupo, foram analisadas por meio de teste t de Student. Além disso, o coeficiente de correlação de Pearson foi utilizado. RESULTADOS: alterações dentoalveolares significativas foram observadas em ambos os grupos. Entretanto, não houve diferenças significativas entre os grupos. Houve uma diminuição da espessura óssea na região posterior e das medidas transversais em ambos os grupos. Não houve uma correlação significativa entre a espessura óssea posterior e a expansão da arcada dentária, em nenhum dos dois sistemas de braquetes utilizados. CONCLUSÕES: comparando-se o uso dos aparelhos autoligáveis e convencionais, concluiu-se que não houve diferenças dentoalveolares significativas quanto à expansão da arcada inferior e quanto à espessura óssea posterior.
BACKGROUND AND OBJECTIVES: Physical evaluation of temporomandibular disorder patients commonly includes evaluation of pain response to muscular and articular palpation and there is a considerable uncertainty of how self-reported pain intensity relates to Pressure Pain Threshold obtained in an algometry exam. The present study aimed at determining whether pain intensity is associated to Pressure Pain Threshold in temporomandibular disorder patients. METHODS: Eighty arthralgia patients and one hundred and thirty masticatory myofascial pain patients participated in this study. Pain intensity was recorded with visual analog scale. Pressure Pain Threshold was measured using a pressure algometer. Pressure was applied bilaterally on the temporomandibular joint in arthralgia patients and masseter and anterior temporalis muscles. Pearson correlation coefficient (r) was calculated to determine the strength of the relationship between pain intensity and the lowest Pressure Pain Threshold value in each site. RESULTS: The correlation between all pain intensity and Pressure Pain Threshold values was statistically weak. Correlations between pain intensity and joint Pressure Pain Threshold (r=- 0.236; p=0.035) in the arthralgia group and pain intensity and masseter’s Pressure Pain Threshold (r=-0.312; p<0.001) and between pain intensity and anterior temporalis Pressure Pain Threshold (r=-0.240; p=0.006) were statistically significant. CONCLUSION: The weak correlation between pain intensity and Pressure Pain Threshold suggests that other factors are clearly important in explaining the pain experience of temporomandibular disorder patients, including the contribution of central nervous system nociceptive processes and psychological variables to the maintenance of chronic pain.
JUSTIFICATIVA E OBJETIVOS: A avaliação clínica de pacientes com disfunção temporomandibular inclui a avaliação da resposta dolorosa à palpação muscular e articular e existe uma incerteza sobre como a intensidade da dor relatada pelo paciente se relaciona com o limiar de dor à pressão obtido com exame de algometria. O presente estudo objetivou determinar se há uma associação entre essas duas variáveis. MÉTODOS: Oitenta pacientes com artralgia e 130 com dor miofascial mastigatória participaram deste estudo. A intensidade de dor foi aferida com a escala visual analógica. O limiar de dor à pressão foi aferido utilizando o algômetro. A pressão foi aplicada bilateralmente na articulação temporomandibular nos pacientes com artralgia e nos músculos masseter e temporal anterior. O teste utilizado na análise estatística foi o coeficiente de correlação de Pearson (r) para determinar a força da correlação entre intensidade de dor e o menor valor de limiar de dor à pressão. RESULTADOS: As correlações entre os valores de intensidade de dor e limiar de dor à pressão foram estatisticamente fracas. As correlações entre intensidade de dor e limiar de dor à pressão na articulação temporomandibular (r=-0,236; p=0,03), no masseter (r=-0,312; p<0,001) e no temporal anterior (r=-0,240; p=0,006) foram estatisticamente significantes. CONCLUSÃO: A baixa correlação entre intensidade de dor e limiar de dor à pressão sugere que outros fatores possam ser claramente importantes para explicar a experiência dolorosa de pacientes com disfunção temporomandibular, incluindo a contribuição do processo nociceptivo no sistema nervoso central e as variáveis psicossociais para a manutenção da dor crônica.
This cross-sectional study aimed at assessing the cephalometric characteristics in the elderly, taking into account differences between genders, age ranges, ethnic groups and dental aspects. The sample consisted of 250 elderly subjects of both genders (163 female, mean age: 68 yr.; 87 male: 70.4 yr.). Conventional lateral cephalograms for cephalometric analysis were scanned and analyzed by Dolphin Imaging software 11.5. The statistical treatment of the data evaluated the influence of gender and age range variables (independent ttest), as well as ethnic group, facial profile, and dental characteristics (one-way ANOVA), on cephalometric measurements. A confidence interval of 95% and level of significance of 5% were considered for all the tests performed. The results revealed: 1) The cephalometric measurements evaluated showed significantly lower values for the female gender; 2) a significant decrease in the cephalometric values was observed in relation to the growth pattern, with the advancement of age; 3) significant cephalometric differences were observed between the ethnic groups and the facial profiles; 3) dentulous patients had greater absolute values for all the components evaluated, followed by the individuals with partial dental losses and by those who were edentulous. It may be concluded that the cephalometric alterations observed in this study are inherent to facial maturity, and that they represent specific characteristics regarding each of the variables evaluated. These modifications must be taken into account when planning the treatment for younger patients, to minimize the modifications arising from the natural aging process.
Purpose: This study investigated the prevalence of Temporomandibular Disorders (TMD) in the elderly and its association with palpation of the temporomandibular joint (TMJ), masticatory and cervical muscles as well as the presence of headache and joint noises. Methods: The sample consisted of 200 elderly of both genders (mean age: 69.2±5.7 years). The clinical evaluation of TMD signs and symptoms was divided into three stages: an anamnestic questionnaire, a TMJ evaluation, and a muscular examination. The results were analyzed through descriptive statistics as well as using χ2 and the tendency tests. Results: The presence of TMD was observed in 61% of the sample (mild: 43.5%, moderate: 13%, severe: 4.5%). A significantly greater prevalence of TMD was found for females (72.4%) compared with that for men (41.1%) (p<0.0001). Additionally, a significant association among TMD severity and palpation of the TMJ (p=0.0168), of masticatory muscles (p<0.0001), and of cervical muscles (p<0.0001) was verified. Also, there was a significant association between the frequency of headaches and the presence of TMD (p=0.0001). The association between the presence of joint noises and sensitivity to TMJ palpation was not significant. Conclusion: The elderly presented high TMD prevalence, mostly in females, with mild severity and related to TMJ and masticatory/cervical muscles palpation. Thus, the accomplishment of a detailed clinical examination to investigate the presence of such disorders is essential and it must not be neglected during the treatment of elderly patients.
Objetivo: O objetivo deste estudo foi investigar a prevalência de Transtornos Temporomandibulares (DTM) em idosos e sua associação com a palpação da articulação temporomandibular (ATM), dos músculos mastigatórios e cervicais, bem como com a presença de dores de cabeça e ruídos articulares. Métodos: A amostra foi composta por 200 idosos, de ambos os gêneros (média de idade: 69,2±5,7 anos). A avaliação clínica dos sinais e sintomas foi dividida em três etapas: aplicação de questionário anamnésico, avaliação da ATM e exame muscular. Os resultados foram avaliados por meio de estatística descritiva, teste do χ2 e teste de tendência. Resultados: A presença de DTM foi observada em 61% da amostra (leve: 43,5%, moderada: 13%, intensa/grave: 4,5%). Verificou-se prevalência significantemente maior de DTM para as mulheres (72,4%) em comparação aos homens (41,1%) (p<0,0001). Houve associação significante entre a severidade da DTM e a presença de dor à palpação da ATM (p=0,0168), dos músculos mastigatórios (p<0,0001) e cervicais (p<0,0001). Observou-se associação significante entre a frequência de dores de cabeça e a presença de DTM (p=0,0001). Não houve associação significante entre a presença de ruídos articulares e a sensibilidade à palpação da ATM. Conclusão: Os idosos apresentaram alta prevalência de DTM, em sua maioria no gênero feminino, de grau leve, relacionada à palpação na ATM e nos músculos mastigatórios e cervicais. Assim, é essencial a realização de um completo exame clínico para investigar a presença desses transtornos, especialmente durante o tratamento de idosos.
Objective: The aim of this study was to compare the reliability of three different methods of cephalometric analysis. Material and Methods: Conventional pretreatment lateral cephalograms and cone beam computed tomography (CBCT) scans from 50 subjects from a radiological clinic were selected in order to test the three methods: manual tracings (MT), digitized lateral cephalograms (DLC), and lateral cephalograms from CBCT (LC-CBCT). The lateral cephalograms were manually analyzed through the Dolphin Imaging 11.0™ software. Twenty measurements were performed under the same conditions, and retraced after a 30-day period. Paired t tests and the Dahlberg formula were used to evaluate the intra-examiner errors. The Pearson's correlation coefficient and one-way analysis of variance (ANOVA) tests were used to compare the differences between the methods. Results: Intra-examiner reliability occurred for all methods for most of the measurements. Only six measurements were different between the methods and an agreement was observed in the analyses among the 3 methods. Conclusions: The results demonstrated that all evaluated methodologies are reliable and valid for scientific research, however, the method used in the lateral cephalograms from the CBCT proved the most reliable.
Skeletal Class III malocclusion, with its unpredictable and unfavorable nature, has been characterized by a growth pattern with doubtful prognosis regarding orthodontic mechanics, even when performed early. For a long time, Class III malocclusion was regarded as a synonym of mandibular prognathism, regardless of the affected skeletal structures. Mandibular growth, essentially determined by genetic factors, could barely be controlled by early orthodontic interventions. Therefore, the treatment choice was to wait for the patient to grow, and then make an orthodontic intervention associated with an orthognathic surgery. Maxillary involvement in the etiology of Class III malocclusion was conclusive to change orthodontic therapeutics. Maxillary intramembranous growth has a better response to orthopedic treatment, based on growth control and redirection, thus contributing for early intervention success. In several cases, excellent results have been achieved with rapid maxillary expansion and protraction. The aim of this study was to describe and discuss the treatment of a patient with Class III malocclusion, whose treatment planning comprised two phases: interceptive (mechanical orthopedic appliances) and comprehensive (fixed orthodontic appliance). The results of this case showed that Class III malocclusion should be intercepted as early as possible to permit growth redirection, mainly when the maxilla is the primary etiologic factor or dental and/or functional factors are involved. Diagnosis, treatment planning and prognosis depend on patient age, growth potential and severity of malocclusion. Early intervention, adequate indication of appliances, and patient compliance are key factors for good outcomes.
Resumo A má oclusão de Classe III esquelética, com sua imprevisibilidade e natureza potencialmente desfavoráveis, caracteriza um padrão de crescimento com duvidoso prognóstico à mecânica ortodôntica, ainda que esta seja realizada precocemente. Durante muito tempo, a Classe III foi considerada sinônimo de prognatismo mandibular, independente das estruturas esqueléticas comprometidas. O crescimento mandibular, determinado essencialmente por fatores genéticos, dificilmente seria controlado pela intervenção ortodôntica precoce. Assim, optava-se por aguardar o crescimento e então realizar a intervenção ortodôntica associada à cirurgia ortognática. A constatação de envolvimento da maxila como etiologia primária na má oclusão de Classe III foi decisiva para a mudança da terapêutica. O crescimento maxilar, de origem intramembranoso, responderia melhor ao tratamento por meio do controle e direcionamento do crescimento, contribuindo para o sucesso da intervenção precoce. Em muitos casos, excelentes resultados são obtidos com a expansão rápida e protração da maxila. O presente trabalho objetiva descrever e discutir o tratamento de uma paciente com má oclusão de Classe III, cujo plano de tratamento consistiu de duas fases: interceptora, realizada com aparelhos ortopédicos mecânicos e corretiva, com aparelho ortodôntico fixo. Os resultados deste caso clínico demonstraram que a má oclusão de Classe III deve ser interceptada o mais precoce possível, com vistas a redirecionar o crescimento. Esta abordagem deve acontecer, especialmente, quando a maxila é o fator etiológico primário ou quando fatores dentários e/ou funcionais estiverem envolvidos na determinação desta má oclusão. O diagnóstico, o plano de tratamento e o prognóstico dependem da idade do paciente, do potencial de crescimento e da severidade da má oclusão. A intervenção precoce, a indicação de aparelhos adequados e a colaboração do paciente constituem fatores determinantes para a obtenção do sucesso desejado.