Jorge Abrão

Análise Facial Subjetiva

INTRODUCTION: facial analysis has been an important diagnostic method since the beginning of Orthodontics. Many authors have tried to define references of beauty to be reached with orthodontic treatment. This preoccupation is in accordance with patient expectation with orthodontic treatment. The main motivation for them is esthetic improvement. To solve it successfully orthodontists must know witch parameters the population use for esthetic evaluation. With suggest, through this paper, the Subjective Facial Analysis, esthetic and morphologic. AIM: to evaluate the application of the analysis proposed. METHODS: it was asked a heterogeneous group (14 orthodontists, 12 laymen, 7 artists) to classify 100 photographs of facial profile as esthetically pleasant (grades 7, 8 or 9), acceptable (grades 4, 5 or 6) or unpleasant (grades 1, 2 or 3). Eigthy nine percent of the sample was esthetically acceptable, 8% esthetically unpleasant and 3% esthetically pleasant. The nose and the chin were the structures of the facial profile more frequently related by appraisers (38.35% and 18.9% respectively) as responsible for the unpleasant esthetic appearance. CONCLUSION: subjective Facial Analysis is a diagnostic tool, important because is the parameter used by patients and relatives to evaluate the results of orthodontic treatment.

Reproducibility, reliability and validity of measurements obtained from Cecile3 digital models.

The aim of this study was to determine the reproducibility, reliability and validity of measurements in digital models compared to plaster models. Fifteen pairs of plaster models were obtained from orthodontic patients with permanent dentition before treatment. These were digitized to be evaluated with the program Cécile3 v2.554.2 beta. Two examiners measured three times the mesiodistal width of all the teeth present, intercanine, interpremolar and intermolar distances, overjet and overbite. The plaster models were measured using a digital vernier. The t-Student test for paired samples and interclass correlation coefficient (ICC) were used for statistical analysis. The ICC of the digital models were 0.84 +/- 0.15 (intra-examiner) and 0.80 +/- 0.19 (inter-examiner). The average mean difference of the digital models was 0.23 +/- 0.14 and 0.24 +/- 0.11 for each examiner, respectively. When the two types of measurements were compared, the values obtained from the digital models were lower than those obtained from the plaster models (p < 0.05), although the differences were considered clinically insignificant (differences < 0.1 mm). The Cécile digital models are a clinically acceptable alternative for use in Orthodontics.

Increase of condylar displacement between centric relation and maximal habitual intercuspation after occlusal splint therapy

The present study assessed condylar displacement between initial maximal habitual intercuspation (MHI) and centric relation (CR), recorded after using a deprogramming occlusal splint for an average period of 7.8 +/- 2.1 months prior to any orthodontic treatment. The sample consisted of 22 subjects, 11 male and 11 female, with an average age of 14.2 +/- 1.4 years, with Class II malocclusion and with no apparent signs or symptoms of temporomandibular dysfunction (TMD). Condylar displacement was measured using a Panadent axis position indicator in decimal fractions of a millimeter. The original mean vertical displacements and the corresponding standard deviations were 4.24 +/- 2.53 mm and 3.86 +/- 2.72 mm, respectively, for the right and left sides. Because a significant negative correlation was observed between original condylar displacements and age factors, the displacement values were statistically adjusted to 2.74 +/- 2.00 mm and 2.44 +/- 1.93 mm. On the horizontal plane, the mean displacements measured were -0.72 +/- 1.53 mm on the right side and -0.51 +/- 1.98 mm on the left. The mean displacement on the transversal plane was 0.03 +/- 0.87 mm. A comparison between these values and those observed in non-deprogrammed groups, as well as those published in the related literature, indicates that use of occlusal splints results in greater mean condylar displacement values, especially vertically, between CR and MHI positions, which contributed to a more accurate orthodontic diagnosis.

Análise facial numérica do perfil de brasileiros Padrão I

AIM: the aim of this study was to determine measurements of the facial profile in balanced faces of Pattern I Brazilian patients. METHODS: the sample was comprised by 50 Brazilian adults (32 women and 18 men) selected by morphologic facial analysis in frontal and lateral views. Standardized lateral facial photographs were taken. They were measured for two different researches to obtain the following: 1) nasolabial angle; 2) angle of mentolabial fold; 3) interlabial angle; 4) angle of facial convexity; 5) angle of total facial convexity; 6) angle of the lower third of the face; 7) proportion between medium facial height and lower facial height; 8) proportion of the lower third of the face. RESULTS AND CONCLUSIONS: there was no statistical difference between the two measurements. The averages, standard deviation, minimal and maximal values obtained were: 1) nasolabial angle: 108.13° ± 9.75° (81° to 127°); 2) angle of mentolabial fold: 132.37° ± 9.82° (110.5° to 152°); 3) interlabial angle: 135.35° ± 11.14° (116.5° to 159.5°); 4) angle of facial convexity: 12.32°± 3.93° (4° to 19.5°); 5) angle of total facial convexity: 137.85° ± 4.08° (129.5° to 147.5°); 6) angle of lower third of the face: 103.41° ± 8.12° (88° to 124°); 7) proportion between medium facial height and lower facial height: 0.93 ± 0.10 (0.80 to 1.21); 8) proportion of lower third of the face: 0.45 ± 0.06 (0.30 to 0.66). With those results, we intend to determine values of reference for the measurements of facial profile, establishing averages and standard deviation to be used comparatively in the study and treatment of compromised faces of white Brazilians adults.

Estudo comparativo do perfil facial de indivíduos Padrões I, II e III portadores de selamento labial passivo

Objetivo: avaliar as caracteristicas numericas do perfil facial. Metodologia: avaliou-se uma amostra de 50 individuos, brasileiros, adultos, leucodermas, portadores de selamento labial passivo, classificados pela avaliacao morfologica do perfil em 41% Padrao II e 9% Padrao III. A analise facial numerica do perfil foi realizada em fotografias padronizadas. As medidas obtidas para as variaveis estudadas nos dois padroes foram comparadas entre si e com as do Padrao I por meio da Analise de variância (ANOVA) complementada pelo Teste de Tukey. Resultados e Conclusoes: nao foram observadas diferencas estatisticas entre os Grupos Padrao I, II e III nas medidas obtidas para os ângulos nasolabial e do sulco mentolabial e a proporcao entre as alturas faciais media e inferior. O ângulo interlabial foi mais obtuso no Padrao III. Esse Padrao tambem apresentou menor convexidade facial e menor proporcao do terco inferior da face. O ângulo do terco inferior da face, que avalia a protrusao mandibular, foi mais obtuso no Padrao II.

Avaliação dos fatores determinantes da estética do perfil facial

OBJECTIVE: To evaluate the influence of age, gender, sagittal occlusal relationship, facial pattern and 8 facial profile measures on profile aesthetics. METHODS: Contingency tables, chi-square test and Cramers coefficient were used to evaluate the possible association between the scores assigned by 32 examiners (14 orthodontists, 12 laypeople and 6 artists) to the aesthetics of the profile of 100 Brazilian Caucasian adults, all patients with lip seal competence, and age, gender, sagittal occlusal relationship, facial pattern and the variables of the numerical analysis of the facial profile. RESULTS: No association was found between age, gender and sagittal occlusal relationship and the aesthetics of facial profile. An association was observed between profile scores and facial pattern, facial convexity angle and lower face angle. CONCLUSIONS: Among the factors evaluated in this study, facial profile convexity and anterior chin projection were the key determinants of facial profile aesthetics.

Concordância dos ortodontistas no diagnóstico do padrão facial

OBJECTIVE To assess agreement among orthodontists trained in facial pattern diagnosis through the morphological evaluation of the face. METHODS: Facial photographs were taken in front and side view, as well as photos of the smiles of 105 individuals randomly selected among patients seeking orthodontic treatment. The photos were sent to orthodontists trained in facial pattern classification. Intra-rater agreement, agreement between raters and the Gold Standard, as well as inter-rater agreement were assessed using the Kappa index. RESULTS: Intra-rater agreement was almost perfect, with Kappa index reaching 0.85. Agreement between raters and the Gold Standard was moderate (Kappa = 0.48), higher for Pattern I (Kappa = 0.62) and lower for the short face pattern (Kappa = 0.33). Agreement between raters was significant (Kappa = 0.61) and even higher than agreement with the Gold Standard for all patterns. CONCLUSIONS: The criteria used by raters to determine the facial pattern were the same in the first and second evaluation. Agreement between raters and the Gold Standard was moderate, with raters exhibiting greater agreement between them than with the Gold Standard.

Estudo dos sinais de DTM em pacientes ortodônticos assintomáticos

Study the presence of signs of temporomandibular desorders in asymptomatic patients in the beginning, during, and after the orthodontic treatment, to verify if the clinical examination is enough for a proper diagnosis, and if the orthodontic treatment is a factor that contributes for the development of temporomandibular dysfunction on this asymptomatic patients. The orthodontic treatment was not considered contributing factor for development of temporomandibular desorders.

Determination of tooth-size discrepancy and Bolton ratios using Bibliocast Cécile3 digital models.

The purpose of this study was to compare digitized models with their current gold-standard plaster models for tooth-size discrepancy and Bolton analysis. Fifteen pairs of plaster models were obtained from orthodontic patients with permanent dentition. These were digitized and evaluated using the Bibliocast Cécile3 v2.5 software. Two examiners measured three times the mesiodistal width of all the teeth and the arch length, and determined the tooth-size discrepancy and Boltońs ratios. The plaster models were measured using a digital vernier caliper. Interclass correlation (ICC), mean differences and paired t-tests were used for comparisons and statistical analysis. The ICC of the digital models were 0.930 (0.852≤ICC<0.973) for the intra-examiner and 0.929 (0.829≤CCI<0.974) for the inter-examiner. The mean differences between plaster and digital models with respect to the anterior and overall Boltońs ratios for examiner 1 was 0.34 mm for both and for examiner 2 were 0.28 mm and 0.21 mm respectively. Although digital model measurements were lower than plaster (p<0.05), these were considered clinically insignificant (differences<0.1mm). The determination of the tooth-size discrepancy and Bolton analysis using digital models and the Bibliocast Cécile3 software are an acceptable alternative to use in clinical practice.

Correlation between transverse expansion and increase in the upper arch perimeter after rapid maxillary expansion

The purpose of the present study was to assess the correlation between transverse expansion and the increase in upper arch perimeter, after maxillary expansion. Dental casts of eighteen patients were obtained before treatment and again five months after maxillary expansion. Measurements of intermolar width, intercanine width, arch length and arch perimeter were made with a digital caliper on photocopies taken from the dental casts. After assessment of the method error, a multiple regression model was developed following the identification of the best subset of variables. The resulting equation led to the conclusion that the increase in arch perimeter is approximately given by the addition of 0.54 times the intercanine expansion, and 0.87 times the arch length alteration.