Sílvia Augusta Braga Reis

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.

Características cefalométricas do padrão face longa

Este estudo determinou as caracteristicas cefalometricas dos individuos portadores de Padrao Face Longa em comparacao com individuos Padrao I. Um total de 73 telerradiografias em norma lateral, sendo 34 Padrao Face Longa e 39 Padrao I, foram selecionadas com base na morfologia facial, nao considerando as relacoes oclusais e sagitais. Foram avaliados: padrao de crescimento facial, alturas faciais anteriores e posterior, relacao maxilo-mandibular, alem das relacoes dentarias com suas bases apicais. De uma forma geral, os individuos Padrao Face Longa apresentaram grandes desvios em relacao aos individuos Padrao I, sendo a doenca decorrente de um desequilibrio entre os componentes verticais. Pode-se observar que os valores das grandezas AFAT, AFAI, AFATperp, AFAIperp, 1-PP, 6-PP, 1-PM, SNB, ANB, ângulo goniaco, ângulo plano mandibular, alem das proporcoes AFAI/AFAT e AFAIperp/AFATperp, estavam significantemente alterados para os individuos Pa drao Face Longa. Com base nos resultados obtidos neste estudo, verificou-se que esses individuos caracterizavam-se pelo padrao de crescimento vertical e por um aumento da altura facial anterior inferior - consequentemente, da altura facial anterior total - estando a deformidade localizada abaixo do plano palatino. Foram observados ainda um retrognatismo maxilar e mandibular, alem da presenca de extrusao dentaria anterior (superior e inferior) e postero-superior, com os incisivos superiores bem posicionados em suas bases e os inferiores lingualizados. Resumo

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.

Características cefalométricas dos indivíduos Padrão I

The aim of this study was to determine cephalometric characteristics of Pattern I patients, to establish averages, and mainly, standard deviation references to be used comparatively with values of skeletally compromised cases. The sample was comprised by 30 white brazilian adults selected by morphologic facial analysis in lateral photographs. In the study of facial growth pattern, the palatine plane angle was 9,4°± 3,2°, while goniac angle was 121,4°± 5,3°, both with sexual dimorphism. For the mandibular plane angle, the value was 29,2°± 4,2°, without sexual dimorphism. The average values for total, lower, medium and posterior facial height were, respectively, 123,0mm± 8,3mm, 68,8mm± 6,6mm, 55,9mm± 3,5mm e 62,6mm± 4,7mm. For all those measures, feminine values were smaller then masculine ones. Cephalometric position of maxillary and mandibular bones confirmed the skeletal balance of the sample. SNA was 82,2° ± 2,9°, SNB was 79,8° ± 2,5° and ANB was 2,4° ± 1,4°, without sexual dimorphism. Maxillary length was 95,2mm ± 5,7mm, while mandibular length was 124,2mm ± 8,2mm, with sexual dimorphism. Upper and lower incisors were more protruded them those of literature samples. Upper incisors were studied by 1.PP angle, and the average was 115,2° ± 5,5°, while the value for IMPA was 93,9° ± 5,7°.

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.

Perception of adults' smile esthetics among orthodontists, clinicians and laypeople

OBJECTIVE: Smile esthetics has become a major concern among patients and orthodontists. Therefore, the aim of this study was: (1) To highlight differences in perception of smile esthetics by clinicians, orthodontists and laypeople; (2) To assess factors such as lip thickness, smile height, color gradation, tooth size and crowding, and which are associated with smile unpleasantness. METHODS: To this end, edited photographs emphasizing the lower third of the face of 41 subjects were assessed by three groups (orthodontists, laypeople and clinicians) who graded the smiles from 1 to 9, highlighting the markers that evince smile unpleasantness. Kruskall-Wallis test supplemented by Bonferroni test was used to assess differences among groups. Additionally, the prevailing factors in smile unpleasantness were also described. RESULTS: There was no significant difference (P = 0.67) among groups rates. However, the groups highlighted different characteristics associated with smile unpleasantness. Orthodontists emphasized little gingival display, whereas laypeople emphasized disproportionate teeth and clinicians emphasized yellow teeth. CONCLUSION: Orthodontists, laypeople and clinicians similarly assess smile esthetics; however, noticing different characteristics. Thus, the orthodontist must be careful not to impose his own perception of smile esthetics.

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.

Avaliação comparativa dos efeitos maxilares da expansão rápida da maxila com os aparelhos de Haas e Hyrax

AIM: the purpose of this cephalometric study was to evaluate, by lateral cephalograms, the changes in maxilar positioning after rapid disjunction of the midpalatal suture, following the use of two types of maxillary disjunction appliances, checked in different phases, and the likely differences between the two appliances Haas and Hyrax. METHODS: the sample comprised of 93 lateral cephalograms, taken before treatment (pre-disjunction), immediately after disjunction and at the end of levelling, obtained from 31 brazilian youths with both genres and average age of 13 years and 2 months. RESULTS AND CONCLUSIONS: both types of appliances showed similar results, with anterior and lower displacement of maxila right after disjunction. Lower displacement was without rotation, and mainttened stable until the end of levelling. Anterior displacement, however, was not stable and cephalometric measurements like SNA and Nperp-A tended to returned to initial values at the end of levelling.

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.