Guilherme Thiesen

Comparative study of two skeletal maturation evaluation indexes

OBJETIVO: Comparar o indice de maturacao esqueletica carpal (IMC) e o indice vertebral (IMV) e verificar a confiabilidade do IMV na determinacao desta maturacao. METODOLOGIA: Utilizou-se radiografias dos prontuarios da disciplina de Ortodontia da UNISUL. A amostra foi composta por 158 radiografias, sendo 79 carpais e 79 cefalometricas em norma lateral, de pacientes com idades variando entre 6 e 18 anos, de ambos os sexos. Para a determinacao do IMC utilizou-se o metodo de Martins e para o IMV, o de Baccetti, Franchi e McNamara Jr. RESULTADOS: Os testes de correlacao de Spearman e Pearson mostraram um indice entre IMC e IMV de 0,616 e 0,698, respectivamente, correlacao estatisticamente significante para ambos os sexos (P<0,0001). A correlacao de Spearman e de Pearson entre o IMC e a idade cronologica foi de 0,775 e 0,974, respectivamente. Ja entre o IMV e a idade cronologica foi de 0,563 e 0,717, respectivamente, uma correlacao tambem estatisticamente significante. CONCLUSAO: O IMC e o metodo mais seguro e confiavel de avaliacao da maturacao esqueletica, porem o IMV pode ser usado como metodo substituto quando houver familiaridade com as alteracoes morfologicas das vertebras e quando a radiografia carpal nao estiver disponivel na documentacao ortodontica.

Maxillofacial Features Related to Mandibular Asymmetries in Skeletal Class III Patients

PURPOSE To analyze components related to different degrees of mandibular asymmetry in adults with skeletal Class III using cone-beam computed tomographic (CBCT) images. MATERIALS AND METHODS CBCT images from 138 patients were analyzed. Asymmetry was determined by the deviation of the gnathion point in relation to the midsagittal plane and classified as relative symmetry, moderate mandibular asymmetry, or severe mandibular asymmetry. Several maxillary and mandibular measurements were used to compare different degrees of mandibular asymmetry and the difference between measurements of the contralateral and deviated sides. RESULTS For patients with moderate and severe mandibular asymmetry, there were statistically relevant differences between bilateral measurements of the sagittal position of the condylar heads, the transverse and sagittal positioning of the gonion, ramus height, and mandibular body length, the transverse and vertical positioning of the jugale point, including a vertical positioning of the gonion only for severe asymmetry. In patients with severe mandibular asymmetry, there was a highly relevant correlation of gnathion lateral displacement with lower dental midline displacement and with the difference in height of the mandibular rami between the deviated and contralateral sides. CONCLUSION In patients with skeletal Class III, not only lateral displacement of the menton but also a series of morphologic changes differed markedly for each degree of mandibular asymmetry.

Pharyngeal airway evaluation after isolated mandibular setback surgery using cone-beam computed tomography

Introduction: In this study, we investigated volumetric and dimensional changes to the pharyngeal airway space after isolated mandibular setback surgery for patients with Class III skeletal dysplasia. Methods: Records of 28 patients who had undergone combined orthodontic and mandibular setback surgery were obtained. The sample comprised 17 men and 11 women. Their mean age was 23.88 ± 6.57 years (range, 18‐52 years). Cone‐beam computed tomography scans were obtained at 3 time points: before surgery, average of 6 months after surgery, and average of 1 year after surgery. Oropharyngeal, hypopharyngeal, and total volumes were calculated. The lateral surface and anteroposterior dimensions at the minimal axial areas for oropharyngeal and hypopharyngeal volumes and mean mandibular setback were determined. Results: The mean mandibular setback was 9.93 ± 5.26 mm. Repeated measures analysis of variance determined an overall significant decrease between the means for 6 months and up to 1 year after surgery for oropharyngeal and hypopharyngeal volumes, anteroposterior at oropharyngeal, lateral surface at oropharyngeal, and anteroposterior at hypopharyngeal. No strong correlation between mandibular setback surgery and pharyngeal airway volumes or dimensions was determined. Conclusions: After mandibular setback surgery, pharyngeal airway volume, and transverse and anteroposterior dimensions were decreased. Patients undergoing mandibular setback surgery should be evaluated for obstructive sleep apnea and the proposed treatment plan modified according to the risk for potential airway compromise. HighlightsPharyngeal airway volume is decreased after isolated mandibular setback surgery.Lateral and anteroposterior oropharyngeal dimensions also decrease significantly.Anteroposterior hypopharyngeal dimension decreases.Amounts of mandibular setback and pharyngeal airway change are not strongly correlated.Amount of mandibular setback surgery could not predict pharyngeal airway changes.

Criteria for determining facial asymmetries

We read with great interest the article entitled “Evaluation of facial hard and soft tissue asymmetry using cone-beam computed tomography” in the February issue of the Journal. The authors evaluated facial asymmetry 3 dimensionally using cone-beam computed tomography and compared the right and left facial hard and soft tissues linearly and volumetrically. They used an innovative and interesting methodology, so we need to congratulate them. However, their outcome was established using a wrong assumption. They stated that “Patients with less than 4 mm of Me0 deviation from the midsagittal reference line were categorized as symmetric and comprised the control group, whereas patients with 4 mm or more of Me0 deviation comprised the asymmetry group, similar to the study of Haraguchi et al.” However, what Haraguchi et al really stated in their article was “The results.suggest that faces having skeletal chin deviation of more than 4 mm are likely to be judged also with soft tissue facial asymmetry.” Therefore, it seems that skeletal deviation must be equal to or greater than 4 mm to render the asymmetry visible in a persons face. Whenever the degree of asymmetry is lower, the condition tends to be considered mild and unperceivable. Nevertheless, asymmetry perception or blinding will also depend on individual characteristics, such as soft tissue thickness in that region. For this reason, other authors consider an asymmetrical face as having bony deviations equal to or greater than 2 mm. That is why even nowadays we still have some doubts for establishing the criteria for facial asymmetries. It is particularly important since, without specific limits, studies usually use different boundaries. Its seems therefore that Nur et al evaluated severe asymmetric cases. But the mentioned point raises real importance, since their control group had a soft tissue menton deviation of 2.17 6 1.11 mm. Several authors have stated that a soft tissue chin deviation of more than 2 mm is considered asymmetry.

Determining the midsagittal reference plane for evaluating facial asymmetries

1. Assael L. Surgical management of odontogenic cysts and tumors. In: Peterson LJ, editor. Principles of oral and maxillafacial surgery. Philadelphia: Lippincott; 1992. p. 698-701. 2. Philipsen HP, Birn H. The adenomatoid odontogenic tumour. Ameloblastic adenomatoid tumour or adeno-ameloblastoma. Acta Pathol Microbiol Scand 1969;75:375-98. 3. Milobsky L, Milobsky SA, Miller GM. Adenomatoid odontogenic tumor (adenoameloblastoma). Report of a case. Oral Surg Oral Med Oral Pathol 1975;40:681-5. 4. Carr RF, Foster LD, Gilliam CH, Evans G. Odontogenic adenomatoid tumors associated with orthodontic treatment. Am J Orthod Dentofacial Orthop 1995;107:648-50. 5. Vitkus R, Meltzer JA. Repair of a defect following the removal of a maxillary adenomatoid odontogenic tumor using guided tissue regeneration. A case report. J Periodontol 1996;67:46-50. 6. Motamedi MH, Shafeie HA, Azizi T. Salvage of an impacted canine associated with an adenomatoid odontogenic tumour: a case report. Br Dent J 2005;199:89-90. 7. McGuff HS, Alderson GL, Jones AC, Edgin WA. Oral and maxillofacial pathology case of the month. Adenomatoid odontogenic tumor. Tex Dent J 2008;125:1192-5. 8. Root RW. Adenoameloblastoma: report of case. J Oral Surg 1963; 21:515-8. 9. Abrams AM, Melrose RJ. Odontogenic adenomatoid tumor. Clinical pathologic conference No. 19. J South Calif Dent Assoc 1972;40:108-11. 10. Toida M, Hyodo I, Okuda T, Tatematsu N. Adenomatoid odontogenic tumor: report of two cases and survey of 126 cases in Japan. J Oral Maxillofac Surg 1990;48:404-8. 11. Holroyd I, Rule DC. Adenomatoid odontogenic tumour in a 12year-old boy. Int J Paediatr Dent 1997;7:101-6. 12. Bonardi JP, da Costa FH, Matheus RA, Ito FA, Pereira-Stabile CL. Rare presentation of adenomatoid odontogenic tumor in a pediatric patient: a case report. Oral Maxillofac Surg 2016;20:215-7. 13. Rick GM. Adenomatoid odontogenic tumor. Oral Maxillofac Surg Clin North Am 2004;16:333-54. 14. Hupp JR, Ellis E III, Tucker MR. Contemporary oral and maxillofacial surgery. 8th ed. St Louis: Elsevier-Mosby; 2014. p. 454. 15. Miyawaki S, Hyomoto M, Tsubouchi J, Kirita T, Sugimura M. Eruption speed and rate of angulation change of a cystassociated mandibular second premolar after marsupialization of a dentigerous cyst. Am J Orthod Dentofacial Orthop 1999; 116:578-84. 16. Dayi E, G€ urb€ uz G, Bilge OM, Ciftcioglu MA. Adenomatoid odontogenic tumour (adenoameloblastoma). Case report and review of the literature. Aust Dent J 1997;42:315-8.

Three-dimensional evaluation of craniofacial characteristics related to mandibular asymmetries in skeletal Class I patients

Introduction: Our objective was to analyze the characteristics that affect skeletal Class I adults with mandibular asymmetries using cone‐beam computerized tomography. Methods: The sample included cone‐beam computerized tomography images of 120 subjects. Asymmetry was determined by the deviation of gnathion from the midsagittal plane and classified as relative symmetry, moderate asymmetry, or severe asymmetry. Maxillary and mandibular measurements were made, and the differences between the contralateral side and the deviated side were evaluated, as well as the differences between the categories of asymmetry. Results: For patients with moderate asymmetry, there were significant differences between the contralateral and deviated sides for some measuments in the transverse and vertical planes. For those with severe asymmetry, statistically significant differences were found between the sides for all measurements, except for the measuments that evaluated the position of the mandibular condyle in the transverse and sagittal directions. Furthermore, a strong correlation was found in patients with severe asymmetry, between the deviation of the mandibular dental midline and the lateral displacement of gnathion. Conclusions: Patients with relative symmetry had a bilateral balance, whereas those with moderate and severe asymmetries showed several skeletal imbalances. A great deviation of the mandibular dental midline may indicate severe skeletal asymmetry in Class I adults. HIGHLIGHTSMandibular asymmetry presents morphologic features, notably lateral chin deviation.Patients with relative symmetry differed from those with moderate or severe asymmetry.Lower midline and gnathion deviations were correlated in Class I patients with severe asymmetry.

Orthodontic treatment of a patient with maxillary lateral incisors with dens invaginatus: 6-year follow-up.

Introduction: Dens invaginatus is an anomaly of dental development in which calcified tissues, such as enamel and dentin, are invaginated into the pulp cavity. This morphologic alteration is more frequent in maxillary permanent lateral incisors and makes them more susceptible to carious lesions and pulp alterations. Methods: This case report describes a patient with maxillary lateral incisors affected by dens invaginatus. The maxillary right lateral incisor had already undergone endodontic treatment, and the maxillary left one had a periapical lesion. Additionally, the patient had a Class II Division 1 malocclusion, with anterior open bite, posterior crossbite, and an impacted mandibular left second molar. Results: The orthodontic treatment involved extraction of the maxillary lateral incisors and 2 mandibular premolars, resulting in proper overjet and overbite with good arch coordination and occlusal stability. Conclusions: Treatment results were stable, as evaluated in a 6‐year posttreatment follow‐up. HighlightsDens invaginatus can lead to premature caries and pulp infections.Orthodontic treatment can include extraction of an affected lateral incisor.Long‐term follow‐up confirmed the stability of this treatment alternative.

Cephalometric evaluation of adult anterior open bite non-extraction treatment with Invisalign

ABSTRACT Objective: The purpose of this study was to evaluate, by means of cephalometric appraisal, the vertical effects of non-extraction treatment of adult anterior open bite with clear aligners (Invisalign system, Align Technology, Santa Clara, CA, USA). Methods: Lateral cephalograms of 30 adult patients with anterior open bite treated using Invisalign (22 females, 8 males; mean age at start of treatment: 28 years and 10 months; mean anterior open bite at start of treatment: 1.8 mm) were analyzed. Pre- and post-treatment cephalograms were traced to compare the following vertical measurements: SN to maxillary occlusal plane (SN-MxOP), SN to mandibular occlusal plane (SN-MnOP), mandibular plane to mandibular occlusal plane (MP-MnOP), SN to mandibular plane (SN-MP), SN to palatal plane (SN-PP), SN to gonion-gnathion plane (SN-GoGn), upper 1 tip to palatal plane (U1-PP), lower 1 tip to mandibular plane (L1-MP), mesiobuccal cusp of upper 6 to palatal plane (U6-PP), mesiobuccal cusp of lower 6 to mandibular plane (L6-MP), lower anterior facial height (LAFH), and overbite (OB). Paired t-tests and descriptive statistics were utilized to analyze the data and assess any significant changes resulting from treatment. Results: Statistically significant differences were found in overall treatment changes for SN-MxOP, SN-MnOP, MP-MnOP, SN-MP, SN-GoGn, L1-MP, L6-MP, LAFH, and OB. Conclusions: The Invisalign system is a viable therapeutic modality for non-extraction treatment of adult anterior mild open bites. Bite closure was mainly achieved by a combination of counterclockwise rotation of the mandibular plane, lower molar intrusion and lower incisor extrusion.

An interview with Benedict Wilmes

It is a great pleasure to bring to the readers of Dental Press Journal of Orthodontics some of the clinical and scientific knowledge from this great German orthodontist: Prof. Dr. Benedict Wilmes. Dr. Wilmes was raised in Soest, a small village with 50,000 inhabitants in the middle of Germany. He attended Dental School in Muenster, a nice university city near Netherlands. He first received a post-graduate degree in Oral Surgery at the Department of Maxillofacial Surgery at University of Muenster, and subsequently he did a post-graduation in Orthodontics and Dentofacial Orthopedics at the University of Duesseldorf. Dr. Wilmes has published more than 100 articles and textbook chapters. His primary interest is in the area of non-compliant and invisible orthodontic treatment strategies (TADs, lingual Orthodontics and aligners). His favorite hobbies are sports and philosophy. He even was a professional basketball player for the 1st and 2nd divisions in Germany. Lastly, I would like to disclose my gratitude to the DPJO for the opportunity of this interview, to the professors who contributed with the questions, and especially to Dr. Wilmes, who shared his experience and let us know a little more about his brilliant work. Vielen Dank!

Estudo cefalométrico prospectivo dos efeitos da terapia de tração reversa da maxila associada à mecânica intermaxilar

OBJETIVO: o diagnostico e o tratamento precoce do Padrao III sao temas ainda muito discutidos na literatura ortodontica. A tracao reversa associada a expansao rapida da maxila constitui a abordagem mais popular e estudada, produzindo os melhores resultados no menor periodo de tempo. O foco deste estudo foi avaliar as mudancas gradativas ocorridas no complexo dentofacial em criancas com Padrao III de crescimento tratadas com tracao reversa da maxila associada a mecânica intermaxilar. METODOS: a amostra foi constituida por 10 pacientes Padrao III, com media de idade de 8 anos e 2 meses ao inicio do tratamento, tratados consecutivamente com aparelho expansor de Haas modificado, arco lingual modificado, elasticos intermaxilares e mascara de Petit para tracao reversa da maxila por 9 meses. Foram realizadas 4 telerradiografias em norma lateral de cada paciente, uma correspondente ao inicio do tratamento e as demais em intervalos regulares de 3 meses (T1, T2, T3 e T4). As grandezas cefalometricas foram comparadas entre os tempos atraves de Analise de Variância de Medidas Repetidas, complementada pelo Teste de Comparacoes Multiplas de Tukey. RESULTADOS: pode-se observar que as alteracoes esqueleticas mais significativas ocorreram nos primeiros 3 meses de tratamento, sendo que, apos esse periodo, elas se mantiveram constantes ate o final do tratamento. Ocorreram poucas compensacoes dentarias e as alteracoes verticais ocorridas apresentaram significado clinico reduzido. CONCLUSAO: a terapia empregada obteve nao so uma correcao do trespasse horizontal entre as arcadas, mas tambem uma melhora no relacionamento sagital entre as bases osseas e na estetica tegumentar.