Cristina Lúcia Feijó Ortolani

Quantification of cranial base growth during pubertal growth.

Objective To quantify longitudinal cranial base growth from prepubertal through postpubertal stages of development, as defined by biological indicators of individual skeletal maturity (cervical vertebral maturation – CVM) method and to determine if there is sexual dimorphism resulting from cranial base growth. Design A longitudinal cephalometric study. Setting The Dental School of Paulista University, Brazil. Participants 36 subjects (21 females, 15 males) who were part of a longitudinal growth study and exhibited normal facial and normal vertical growth patterns. Methods Growth maturation of cervical vertebrae stages was assessed by two examiners independently. Cranial base measurements were carried out by one individual and repeated after one month. The growth increments over time were assessed with the one-way repeated-measures analysis of variance and post hoc Tukey multiple comparisions. Results There were no significant gender differences. There was a significant increase in all cephalometric measures between the different time points. Ba–Na showed the greatest amount of growth (mean change=2.8 mm). From T2–T3, the greatest amount of growth was found for Se–Na (mean change=3.4 mm) and the lowest for CC–Na (mean change=1.4 mm). Comparing overall changes (T1–T3) all the measurements showed statistically significantly increases (P<0.05). For all comparisons of between-stage changes the cranial base grew more than 2.0 mm during the pubertal growth. Conclusions Linear variables of cranial base showed significant growth during pubertal stages (pre-peak, peak and post-peak). No significant differences.

Morphometric analysis of treatment effects of the Balters bionator in growing Class II patients

OBJECTIVE To investigate the effects of the standard (Class II) Balters bionator in growing patients with Class II malocclusion with mandibular retrusion by using morphometrics (thin-plate spline [TPS] analysis). MATERIALS AND METHODS Thirty-one Class II patients (17 male and 14 female) were treated with the Balters bionator (bionator group). Mean age at the start of treatment (T0) was 10.3 years, while it was 13 years at the end of treatment (T1). Mean treatment time was 2 years and 2 months. The control group consisted of 22 subjects (14 male and 8 female) with untreated Class II malocclusion. Mean age at T0 was 10.2 years, while it was 12.2 years at T1. The observation period lasted 2 years on average. TPS analysis evaluated statistical (permutation tests) differences in the craniofacial shape and size between the bionator and control groups. RESULTS Through TPS analysis (deformation grids) the bionator group showed significant shape changes in the mandible that could be described as a mandibular forward and downward displacement. The control group showed no statistically significant differences in the correction of Class II malocclusion. CONCLUSIONS Bionator appliance is able to induce significant mandibular shape changes that lead to the correction of Class II dentoskeletal disharmony.

Crescimento da base craniana nos diferentes tipos faciais nos relacionamentos maxilomandibulares ortopédicos de Classe I, II e III: parte 3 (Crescimento médio de CF-Po)

OBJETIVO: este estudo retrospectivo avaliou o crescimento medio de CF-Po nos diferentes tipos faciais nos relacionamentos maxilomandibulares ortopedicos de Classe I, II e III. METODOLOGIA: uma amostra aleatoria de 300 pacientes brasileiros leucodermas (131 do genero masculino, 169 do genero feminino), com idade media inicial de 10 anos e 2 meses (dentadura mista) e final de 14 anos e 8 meses (segundos molares em oclusao) e tempo medio de observacao de 4 anos e 5 meses, foi selecionada em uma clinica particular, em Sao Paulo, Brasil. Havia 118 pacientes Classe I, 151 Classe II e 31 Classe III. Todas as 600 radiografias cefalometricas laterais foram obtidas no mesmo aparelho de raios-x. As analises de Ricketts e Schwarz modificadas por Faltin foram usadas. A medida linear CF-Po foi feita manualmente pelo mesmo examinador em T1 e T2. Os relacionamentos foram estudados juntos e separadamente, considerando tipo facial e genero. A analise de variância de ANOVA foi aplicada. RESULTADOS E CONCLUSOES: o tipo facial retrovertido mostrou-se significativamente desfavoravel a correcao de Classe III mandibular no genero masculino; com tendencia desfavoravel a Classe II mandibular e crescimento ântero-posterior favoravel na Classe I. O neutrovertido mostrou-se significativamente favoravel a correcao de Classe III mandibular em ambos os generos; com tendencia favoravel a correcao de Classe II mandibular e ao crescimento ântero-posterior na Classe I. O provertido mostrou-se significativamente desfavoravel a correcao de Classe III em ambos os generos e favoravel na Classe II mandibular e com tendencia favoravel de crescimento ântero-posterior na Classe I, principalmente no genero masculino.

Crescimento da base craniana nos diferentes tipos faciais nos relacionamentos maxilomandibulares ortopédicos de Classe I, II e III: Parte 2 (Crescimento médio de Ba-Na, CC-Na e CC-Ba)

AIM: This retrospective study evaluated the cranial base mean growth in different facial types and orthopedic maxillomandibular relationship. METHODS: A random sample of 300 Brazilian Caucasian patients (131 males, 169 females), initial and final mean age (10 years 2 months-mixed dentition; 14 years 8 months-second molar occlusion) and mean observation time (4 years 5 months) was selected at a private clinic in Sao Paulo. There were 118 Class I; 151 Class II and 31 Class III. All 600 lateral cephalometric radiographs were taken using the same x-rays equipment. Ricketts and Schwarz analyses modified by Faltin were used. The same examiner performed manually the linear measures (Ba-Na, CC-Na and CC-Ba) in T1 and T2. All Classes were studied together and separately considering facial type and gender. Paired t-test and ANOVA were carried out. RESULTS AND CONCLUSIONS: The retroversion facial type grew significantly more in CC-Na in Class II, being unfavorable to Class II correction in females; with favorable tendency in Class III and an expecting growth in Class I. Neutroversion grew significantly more in CC-Na in Class I and II, being unfavorable in Class II; it had equitable growth of CC-Na and CC-Ba in Class III and it had considerably greater mean growth than the retroversion in Class I. Proversion had CC-Na and CC-Ba equitable growth in all Classes, it was significantly favorable in mandibular Class II; favorable tendency in mandibular Class III and it had the greatest mean growth in Class I.

Lingual frenotomy in a newborn, from diagnosis to surgery: a case report

Mailing address: Kleber Rosa de Almeida Rua Luiz Botta 1209 CEP: 03959-000 São Paulo, São Paulo, Brasil Email: kleberfono12@globo.com ABSTRACT This report describes the diagnostic approach and frenotomy in a newborn with breastfeeding difficulty, and the observation and analysis during the following 6 months. The patient was delivered normally and without complications, but showed breastfeeding difficulty during her first 5 days of life. The protocol proposed by Martinelli in 2013 was used to evaluate the lingual frenulum. After applying the protocol, the newborn was determined to require a frenotomy and the urgery was performed. The patient was reassessed using the protocol immediately after surgery and again 24 hours latter. There were improvements in the protocol scores at both reassessments. The newborn was observed and analyzed during the next six months by collecting monthly data from the vaccination card and by asking the mother for information. She was given no food supplements, pacifiers, nor sucked the thumbs, and was fed only breast milk and presented an age-appropriate weight gain. We conclude that the diagnosis using the Martinelli protocol is of fundamental importance to recognizing the need for early intervention and that the frenotomy helped improve the patient’s breastfeeding and swallowing capacity.

Avaliação da mineralização dos segundos molares inferiores como pa-râmetro para a classificação da idade biológica

O presente trabalho teve como objetivo avaliar se a mineralizacao dos segundos molares inferiores permanentes podem ser usados como parâmetro para classificar a idade biologica do individuo. A amostra foi constituida por 129 radiografias panorâmicas, sendo 71 individuos do sexo feminino e 58 individuos do sexo masculino, na faixa etaria de 7 anos a 12 anos e 1 mes. Para a analise da mineralizacao dental foi utilizada a tabela proposta por Nolla (1960) com as radiografias sobre o negatoscopio de marca Softline. Os resultados da analise foram documentados numa planilha do programa Microsoft Excel 2010 contendo o nome completo, data de nascimento, data da tomada radiografica, idade em anos e meses, numero do prontuario, estagio de Nolla (1960) lado direito e lado esquerdo. Foi realizada a analise estatistica e podemos concluir que em nossa amostra nao foi encontrado dimorfismo sexual, que a mineralizacao dentaria ocorre de forma similar do lado direito e esquerdo, e que a mineralizacao dos segundos molares inferiores permanentes podem ser usadas como parâmetro para estimar a idade biologica e cronologica de um individuo.

A influência da anquiloglossia no crescimento e desenvolvimento do sistema estomatognático

ABSTRACT Objective: To critically examine the existing Brazilian and International scientific literature regarding the influence of short lingual frenulum over growth and development of the stomatognathic system, as well as how it impacts the achievement of the shape-function balance. Data sources: An electronic literature search was conducted in databases, including MEDLINE/PubMed, Google Scholar, LILACS, SciELO, and ScienceDirect, using the key words “lingual frenum” and “development”, as well as their equivalents in Brazilian Portuguese. The literature search yielded 51 papers published between January 1997 and the present date; 14 articles of clinical trials were selected for meeting the inclusion criteria and were read in full. Data synthesis: The integrated literature review supported the proposition that some malocclusions are closely related to the presence of ankyloglossia and, although very few clinical trials on this topic have been published so far, there is a consensus among authors concerning the negative effects of functional imbalances over the stomatognathic system’s proper growth and development. Half of the studies found state that surgical interventions for releasing the lingual frenum are both safe and effective, concerning improvement in breastfeeding scores. Moreover, 4 out of the 14 studies included in this integrated review, report a negative influence of ankyloglossia over the orofacial muscular system. Conclusions: There is a consensus among the authors concerning the negative effects of lingual frenulum’s anatomic and functional alterations over craniofacial growth and development. The opinion about the early surgical intervention, however, is not unanimous.

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

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

Avaliação das alterações do plano oclusal em telerradiografias em norma lateral no tratamento de más oclusões de Classe II, 1ª divisão, com Bionator de Balters, em pacientes retrovertidos, neutrovertidos e provertidos

AIM: This work aims to verify the changes of Ricketts functional occlusal plane making use of variables which guide this same plane in the cephalometric analysis of Ricketts and Schwarz-Faltin among patients with Class II, division 1 malocclusion, associated to mandible retrognathism, whose therapy indicated has been Bionatortherapy. METHODS: The sample collected in this retrospective survey has 128 lateral cephalograms of 64 retroverted, neutroverted and proverted individuals, of both genders, at the stage of developing occlusion, either in mixed phase or permanent young. The age scale of individuals selected by the survey goes from 7 years and 1 month up to 13 years and 2 months in the T1 moment, with an initial mean age of 10 years. The mean length of time of treatment has been of 19.7 months. RESULTS AND COONCLUSION: The overall results have been submitted to statistical analysis and have shown that in the group of retroverted patients the occlusal plane goes round clockwise, in the group of neutroverted ones, the occlusal plane did not show up any relevant alterations between moments T1 and T2, and in the group of proverted patients the occlusal plane goes round counterclockwise. The occlusal plane control in the Bionatortherapy through the handle of the Bionator according to the facial type of each patient, through selective worn out acrylic and consequent diversified eruption of the teeth, can indeed cause favorable influence towards the overall growing up of the face in every facial type.