Orientador: Marcio de Moraes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-10T00:58:56Z (GMT). No. of bitstreams: 1 Costa_DelsonJoaoda_D.pdf: 970825 bytes, checksum: 5fb8a6a6078e1fd690481bb889e2f2cf (MD5) Previous issue date: 2007 / Resumo: A associação do tratamento ortodôntico-cirúrgico possibilita bons resultados funcionais e estéticos dos pacientes com deformidades dentofaciais e requer períodos variáveis de ortodontia pré e pós-cirúrgica. A duração destes períodos de ortodontia é influenciada por uma série de características inerentes a cada caso clínico e o seu conhecimento possibilita expectativas reais e a satisfação do paciente. O objetivo deste estudo foi avaliar o tempo de tratamento ortodôntico em pacientes submetidos ao tratamento ortodôntico-cirúrgico e investigar fatores que podem influenciá-lo. Foi realizada avaliação retrospectiva de prontuários de 65 pacientes submetidos à cirurgia ortognática entre 1994 e 2004, operados nos Serviços de Cirurgia e Traumatologia Buco-Maxilo-Faciais da FOP/UNICAMP, São Paulo e Hospital XV, em Curitiba, Paraná. As variáveis. investigadas foram: limitação do tratamento ortodôntico isolado, indecisão do paciente quanto ao procedimento cirúrgico, gravidez, tracionamentos dentários, problemas pessoais e clínicos, faltas excessivas ao tratamento ortodôntico e doenças sistêmicas. A faixa etária compreendeu entre 16 a 45 anos de idade com média de 25,7 anos. Na distribuição quanto ao gênero houve a predominância do gênero feminino (67%) em relação ao gênero masculino (33%), sendo que todos os pacientes eram da raça branca. Os fatores que podem alterar o tempo de tratamento ortodôntico nas fases pré e pós-cirúrgica são discutidos, utilizando a técnica (filosofia) ortodôntica bioprogressiva de Ricketts. A média de tratamento pré-cirúrgico ficou em 21 meses, sendo que no pós-cirúrgico foi de 17 meses com o tempo total de 38meses. A duração do tempo de tratamento ortodôntico não foi influenciada pelas variáveis estudadas. Um estudo prospectivo, com amostra maior, poderia especificar quais variáveis resultam em alterações significativas na duração do tempo de tratamento ortodôntico pré e pós-cirurgia ortognática / Abstract: The purpose of this study was to evaluate the length of the orthodontic treatment on patients submitted to a combined orthodontic-surgical treatment. The study comprised data analysis from the information found on the charts of 65 (sixty-five) patients: 35 (thirty-five) treated at "FOP/UNICAMP", São Paulo, and 30 (thirty) treated at "Hospital XV", in Curitiba, Paraná, from January of 1994 to December of 2004. Patients ranged from 16 to 45 years of age, with an average of 25.7 years. Most of the patients were white females (67%), while 36% were white males. The orthodontic treatment was based on the Ricketts Bio-progressive Orthodontic Philosophy, and factors that could affect the length of orthodontic treatment before and after surgery were Gliscussed. The average length of the orthodontic treatment before surgery was 21 months, while the after surgery average time was 17 months, with a total length of 38 months. Among the factors that can affect the total length of the surgical-orthodontic treatment are: limitations and compensations of the orthodontic treatment, patient reluctance on having the surgical procedure done, pregnancy, impacted teeth, personal and clinical issues, missed orthodontic appointments and systemic diseases. The length of the orthodontic treatment on patients submitted to orthognathic surgery can vary depending on factors related to the difficulty of the technique facing dental and skeletal discrepancies, and the variables related to personal conditions of the patients / Doutorado / Cirurgia e Traumatologia Buco-Maxilo-Faciais / Doutor em Clínica Odontológica

A função mastigatória é uma das principais constituintes do sistema estomatognático e impreterivelmente antecede a absorção de nutrientes pelo organismo humano. A força de mordida é um componente dessa função e um indicador clínico do funcionamento desse sistema. Em sujeitos com deformidade dentofacial, a mastigação está prejudicada devido ao desequilíbrio das relações esqueléticas e musculares maxilomandibulares e da oclusão. A abordagem investigativa tridimensional é única que possui a vantagem de avaliar a morfologia facial nos três planos do espaço, tal como se configura a face humana e a deformidade dentofacial. Portanto, o objetivo deste trabalho foi analisar a variação da morfologia facial em diferentes medidas tridimensionais, assim como verificar possível assimetria na força de mordida e diferenças na distribuição de força e área dos contatos oclusais entre sujeitos com deformidades dentofaciais padrão dentoesquelético II, padrão dentoesquelético III e controles. O estudo foi realizado com 77 sujeitos que compuseram dois diferentes grupos, a saber: deformidade dentofacial (DDF) e controle (GC). O grupo com o diagnóstico de deformidade dentofacial (DDF) foi subdividido segundo a classificação da mesma. Assim, 20 sujeitos classe II (4 homens e 16 mulheres, com média de idade de 26 anos) integraram o subgrupo DDF II, 32 classe III (15 homens e 16 mulheres, com média de idade de 27 anos) formaram o DDF III e 25 voluntários saudáveis (9 homens e 16 mulheres, idade média de 24 anos) compreenderam o GC. Todos foram submetidos à avaliação tridimensional da morfologia facial, por meio de escaneamento facial a laser, medidas de força de mordida pelo gnatodinamômetro, análise da distribuição de força oclusal e área de contato dentário pelo sistema T-Scan. As comparações entre GC e DDF foram realizadas pela Análise de Variância (ANOVA) para amostras independentes. O teste de correlação de Spearman foi aplicado para avaliar as possíveis associações entre as medidas de força de mordida e as medidas antropométricas, além da análise de regressão linear múltipla para identificar as variáveis antropométricas associadas à força de mordida. Foi adotado nível de significância de 5%. Na investigação da morfologia, os sujeitos com DDF apresentaram características específicas e compatíveis com as classes II e III esqueléticas, com aumento da altura facial principalmente em retrognatas. A força de mordida foi menor para o grupo DDF, porém não se diferenciou entre os grupos e não houve assimetrias nesse quesito. A área de contato oclusal evidenciou-se mais deficitária para sujeitos com padrão dentoesquelético III, porém a distribuição de força oclusal não demonstrou diferenças entre os grupos. Pode-se concluir o método de análise tridimensional confirmou achados específicos relevantes no que diz respeito às deformidades dentofacias estudadas. E as proporções faciais foram consideradas fatores influenciadores da magnitude da força de mordida em sujeitos com a deformidade dentofacial. / The masticatory function is the one of the main constituents of stomatognathic system and necessarily precedes the absorption of nutrients by the human organism. Bite force is a component of this function and a clinical parameter of this system\'s health. In dentofacial deformity, chewing is impaired due the imbalance of skeletal and muscular maxillomandibular relationships and of the occlusion. Three-dimensioal investigative approach is unique and has the advantage about the evaluation of facial morphology in the three planes of space, such as the configuration of the human face and dentofacial deformity. Therefore, the objective of this study was to analyze the variation of facial morphology in different three-dimensional measurements, as well as to verify possible asymmetry in bite force and the difference in the distribution of force in dental arc and occlusal contact area between subjects with dentofacial deformities class II, class III and control. The study was performed with 77 subjects who composed two different groups: dentofacial deformity (DDF) and control (CG). The group of dentofacial deformity (DDF) was subdivided according to its classification. Thus, 20 class II subjects (4 men and 16 women, mean age of 26 years old) were included in the DDF II subgroup, 32 class III (15 men and 16 women, mean age of 27 years old) formed DDF III, and 25 healthy volunteers (9 men and 16 women, mean age of 24 years old) comprised the CG. All were submitted to the threedimensional assessment of the facial morphology by laser scanning, bite force measurements by gnatodynamometer, analysis of occlusal force distribution and occlusal contact area by the T-Scan system. Comparisons between CG and DDF groups were performed by Analyses of Variance (ANOVA) for independent samples. Spearman\'s correlation test was applied to evaluate the possible association between bite force and anthropometric measurements, as well as multiple linear regression analysis to identify the anthropometric variables associated to the bite force. A significance level of 5% was adopted. In the investigation of morphology the subjects with dentofacial deformities presented specific features and compatible with the skeletal class II and skeletal class III, with increase of facial height, mainly in retrognathic subjects. The bite force was lower for DDF, did not differentiate between the groups and there were no asymmetries about them. The occlusal contact area was found to be poorer for subjects with class III deformity, but the occlusal force distribution did not show differences between the groups. It can be concluded the three-dimensional analysis method confirmed specific and relevant findings to the studied dentofacial deformities. And the facial proportions were considered factors influencing the magnitude of the bite force in subjects with deformity.

INTRODUCTION: Spinal deformities, including adult spinal deformities (ASD) and adolescent idiopathic scoliosis (AIS), can cause significant pain and disability. Radiographic parameters are measured in order to establish quantitative relationships among spinal alignment and health related quality of life metrics. Various classification systems including the Scoliosis Research Society (SRS)-Schwab and Global Alignment Proportion (GAP) score have been developed to correlate radiographic parameters with relevant clinical outcomes. While the SRS-Schwab Classification is both a coronal and sagittal categorization that correlates to health related quality of life metrics, the GAP score is a newly developed 13-point scale that focuses on sagittal alignment to predict mechanical failure postoperatively. The study aims to evaluate the utility of the GAP score as a method of evaluating radiographic correction and maintenance over one year. METHODS: This was a retrospective analysis of ASD and AIS patients who underwent operative intervention. Patients were evaluated for GAP score changes from preoperative to postoperative and then to a one year follow up. Of the 285 screened patients, 73 had suitable radiographs for measurements. This included 45 ASD patients, 32 of which had one year follow up radiographs, and 28 AIS patients, of which only 19 had one year follow up radiographs. Measurements were obtained by three independent readers. These included pelvic incidence (PI), pelvic tilt (PT), L1-S1 lumbar lordosis (L1-S1 LL), L4-S1 lumbar lordosis (L4-S1 LL), sacral slope (SS), global tilt (GT), and sagittal vertical axis (SVA). GAP score subcategories were calculated and summed to produce the GAP score. RESULTS: The 73 included patients had an average age of 41.8 ± 24.1, BMI of 26.2 ±6.3, and consisted of 51 females (69.9%). All but one radiographic parameters exhibited an Intra Class Correlation (ICC) of over 0.66. PI had an ICC of 0.59 which was likely due to the incomplete visibility of the femoral heads in few radiographs. Among ASD patients, from pre to postoperative, PI-LL significantly decreased from 18° to 5°, PT significantly decreased from 26° to 19°, L1-S1 LL significantly increased from 37° to 47°, L4-S1 LL significantly increased from 28° to 31°, GT significantly decreased from 37° to 25°, SVA significantly decreased from 120 mm to 64 mm, and total GAP score significantly decreased from 8 to 6. For the 32 patients with long term data, the GAP score changed significantly from 9 to 6 to 7 at one year follow up. Of the 32 patients, 14 patients experienced a worsened score at the one year follow up. Among AIS patients, PI-LL increased from 0° to 3°, PT remained 13°, L1-S1 LL decreased from 56° to 53°, L4-S1 LL significantly decreased from 37° to 31°, GT increased from 14° to 16°, SVA decreased from 25 mm to 28 mm, and total GAP score increased from 3 to 4. For the 19 with long term data, the GAP score changed significantly from 3 to 3 to 2 and 2 patients experienced a worsened score at the one year follow up. DISCUSSION: The patient population showed a slight improvement in GAP score among both ASD and AIS groups. The improvement is more pronounced when evaluating with the SRS-Schwab Classification. The GAP score does not emphasize the same radiographic parameters and therefore does not correlate well with the SRS-Schwab Classification. Many patients also experienced a worsened GAP score by the one year follow up which can be attributed to the adjacent superior or inferior region (PJK), thoracolumbar region (construct failure), or compensation at the pelvis through hip flexion. Additionally, GAP is potentially oversensitive to measurement error and rounding differences. Thus, the utility of the GAP score in evaluating spinal deformity patients is questionable and requires further adjustment and evaluation based on prospective studies.

Congenital and developmental limb deformities in canines are rare and can occur as a genetic disorder or be caused by extrinsic factors. Without surgery to correct the deformity, conservative management can be implemented to manage exercise and restrict high-intensity activity of the canine. However, any alteration to the normal gait and locomotive biomechanics of a canine can have significant long-term effects on the musculoskeletal health and quality of life of the canine. To improve quality of life and provide an alternative and more cost-effective approach to surgery, a custom prosthetic was designed and developed for a canine born with a congenital right forelimb deformity. Since canine prosthetics that are currently on the market are limited and expensive, the goal of this thesis was to create a durable and inexpensive prosthetic to stabilize the gait of a canine. A 1-year-old German Shepherd was the single subject of this research project. The major results indicated that the custom-designed, 3D printed prosthetic parts, which included the foot and the body of the prosthetic, were strong enough to withstand the high-impact forces and stresses experienced during the gait of a canine. The results also indicated that the prosthetic was comfortable and did not cause any pain or discomfort to the canine, as well as the prosthetic leg and foot being the correct length to stabilize the gait of the canine and redistribute the body weight of the tripod canine to that of a tetrapod canine. This study also developed and outlined a feasible fabrication process that could be repeated and used to produce other custom prosthetics for canines with rare congenital or development limb deformities as an alternative to surgery. In a future study, fatigue testing, tensile testing, and impact testing should be performed to determine the failure points. Fatigue testing is a critical factor in determining failure of a part.

Whilst literature exists describing prevalence and theories about mechanisms of development of deformity, there is a distinct lack of research that examines how deformity can be measured despite it being an area of identified need. This study established the inter- and intra-rater reliability of the Goldsmith Index of Body Symmetry and examined the relevance of the information it provides within the context of a comprehensive postural assessment for individuals with cerebral palsy in conjunction with a commonly used clinical assessment ... Results demonstrated that high index levels were not exclusively associated with people with windswept deformity. Postural patterns of windsweeping, frog leg (abducting) and scissor (adducting) postures and hip extension were found to occur in all categories, suggesting that asymmetry is not confined to one particular postural pattern. Clinically observable changes were identified through comparison of the supine evaluation and index scores. The flexibility of postural components (or the ability to correct asymmetry) in a supine position for the SD categories demonstrated wide variation. However, subjects in the 3+SD groupings had fixed scoliosis and the majority (83%) also had fixed pelvic obliquity and rotation. All other subjects up to the 3SD category had flexible pelvic obliquity and rotation. No definitive differences in postural components between groups were identified in sitting positions, which was attributed to the influence of gravity on the body in an upright posture. Examination of sitting ability and index level did not demonstrate any relationship, suggesting that greater independence in sitting is not necessarily associated with a lower Goldsmith Index. The study highlighted that assessment of posture is complex, and that no single tool provides the answers required to manage a person’s posture. It demonstrates the need for clinicians to be aware that subjective clinical assessment may not be sufficient to adequately assess and detect changes in posture, and that the Goldsmith Index of Body Symmetry provides objective data that can be used as a powerful adjunct in interpreting clinical assessment and supporting the evaluation of clinical interventions.

Adult Acquired Flatfoot Deformity (AAFD) is a progressive disease characterized by mechanical degeneration of the soft tissue structure in the arch of the foot that leads to changes in joint alignment. Surgical intervention commonly via tendon transfer and bony osteotomy is used to restore arch architecture, however there is a lack of quantitative assessments that measure the success of the surgical correction in vivo. Using plantar pressures via Tekscan® HR Mat and surveys (SF-36, FAOS), pre-operative and post-operative measures for six participants were defined, analyzed and compared. A paired t-test showed significant lateral shift for percent body weight during walking postoperativelyin the forefoot and midfoot regions. However, arch index measurement showed no significant change. The FAOS survey score also improved statistically postoperatively. The surgical correction was successful as deemed by some of these quantitative and qualitative measures.

This thesis focuses on the evaluation of a conservative approach to the hallux valgus deformity. 21 people took part in the empirical study in which the changes were tracked. I worked with a group of women who exercised regularly and a control group. The regularly exercising group participated in a 3-month therapeutic program led by a physiotherapist. Each of the participants was properly examined at the beginning of the program and after three months, when the program finished. Each examination consisted of a kinesiologic analysis, a plantography footprint, a foot X-ray, a pain evaluation (the numeric scale was used) and filling out a scoring scale questionnaire of American Orthopaedic Foot and Ankle Society (AOFAS). The changes of pain of the MTP or IP toe joint, the development of foot arch, changes of the toe valgus angle according to the X-rays and the overall score achieved in the AOFAS questionnaire were statistically evaluated. The ability to isolate toe abduction, right posture of the foot, stability of the axial joints and other changes were followed as well. After comparing the results the conclusion of the study is that the three-months physiotherapist-led program weaken the pain of MTP/IP toe joint, rise the score achieved in the AOFAS questionnaire, improve the foot posture and the overall...

Title: Effects of dance sport in the musculoskeletal system of the individual Objectives: The goal is to musculoskeletal examination of selected individuals and evaluation the effect of dance sport on examined status. The results should be the basis for further research in this area. Methods: Kinesiology analysis, bioimpedance analysis and X-ray were used for scrutiny of the musculoskeletal system. Primary and secondary data were analyzed afterwards. Results: Findings of struktural deformities: flat feet (both), both sided hallux valgus with incipient degenerative changes of I. MTP joint (male), limit angle of I. MTP joint of left leg (female). These deviations are related to the using of dance shoes. Muscle imbalance upper thoracic region and lateral imbalance of tested people are the result of the prescribed holding and leading used in dance. Keywords: dance sport, musculoskeletal system, muscle imbalances, feet deformities

Title: Comparison of Rehabilitation Procedures in the Operative and Conservative Approach to Manage Chest deformity in Children Aim: The aim of this thesis is to determine the efficacy of a conservative approach in the treatment of inverted chest and to compare the effect of therapy with the surgical approach. Methodology of thesis: At the beginning of this project, a total of 9 children and adolescents (n = 9) from 10 years to 21 years of age (mean 15 years), male and female (8: 1) participated. All participants were diagnosed with thoracic deformity of pectus excavatum, which was not indicated for surgery. At the beginning of the project, all probands passed an initial examination, which included an obtaining of anthropometric values using a pelvimeter and a tailor's meter, to assess the anthropometric index and chest circumferences during breathing. Subsequently, a rehabilitation instructions have been given to all participants and all participants have obtained a printed version of these exercises. Results: The results of this study show that in patients with pectus excavatum, the regular and long term exercises, can bring the expected positive results. Especially in subjective complaints, chest flexibility and postural improvement. The final effect of thoracic deformity changes after 3 months...

Artrite reumatóide (AR) é uma doença crônica e multisistêmica, que afeta o indivíduo como um todo. De etiologia desconhecida, possui como característica uma inflamação sinovial, efeitos periarticulares, simétricas e cumulativas. Os principais sinais e sintomas apresentados na fase aguda são as dores nas articulações, edemas e rigidez matinal. E em 75% dos casos acometem membro superiores, com um grande impacto nas habilidades funcionais. Nas mãos, as deformidades podem atingir todas as articulações causando subluxações e deformidades em metacarpofalangenas (MF), interfalangeanas (IF) e punhos. Quando há a destruição dos ligamentos e cartilagens do punho as forças musculares e fatores anatômicos causam o colapso do punho em desvio radial e as articulações MF, como consequência a essas forças anatômicas, também entram em colapso e favorecem o desvio ulnar dessas articulações. Há diferentes recursos utilizados no tratamento desta patologia, sendo um deles o uso de órtese. Assim, este estudo tem por objetivo projetar e desenvolver uma órtese, articulada e original, com função de corrigir a deformidade em desvio ulnar dos dedos e favorecer a funcionalidade. Para tanto os procedimentos metodológicos foram divididos em: Reconhecimento de Necessidades; Especificação e Conceito. Após levantamento Bibliográfico, estudo antropométrico chegou-se ao esboço e ao conceito do projeto. Como resultado obteve-se o primeiro protótipo em material disponível e utilizando o programa CAD solid edge Insight foi proposto um protótipo digitalizado da órtese, definindo as propostas e requisitos necessários para o desenvolvimento da órtese. Como resultados obteve-se dois desenhos digitalizados do protótipo e quatro protótipos em materiais diferentes entre si, compostos por 9 peças (2 hastes laterais, 1 bloqueio ulnar, 3 pulseiras e 3 anéis), que montadas mostram uma órtese articulada. Observou-se que houve bloqueio do desvio ulnar mesmo em pacientes com deformidades mais graves dos dedos. A mesma permitia a flexão e extensão de MFs e punho. Houveram ajustes nos desenhos com o decorrer do estudo, após realização dos testes de bancada. Verificou-se que a órtese poderá ser utilizada bilateralmente, com uso dorsal da haste redonda em mão direita e uso ventral em mão esquerda. A órtese permite a função da mão e possui fácil colocação e manuseio. / Rheumatoid arthritis (RA) is a chronic, multisystem, which affects the individual as a whole. Of unknown etiology, is characterized as a synovial inflammation, periarticular effects, and cumulative symmetrical. The main signs and symptoms in the acute phase are joint pain, swelling and stiffness. And 75% of cases involve upper limb, with a great impact on functional abilities. Deformities in the hands can reach all the joints causing deformities and subluxations metacarpophalangeal (MF), interphalangeal (IF) and wrists. When there is destruction of cartilage and ligaments of the wrist muscle forces and anatomical factors cause the collapse of the wrist in radial deviation and MP joints, the effect of these anatomical forces also favor collapse and ulnar deviation of these joints. There are different resources used in the treatment of this pathology, one being the use of bracing. Thus, this study aims to design and develop a bracing, articulate and original, with the function to correct the deformity in ulnar deviation of fingers and promote functionality. For both methodological procedures were divided into: Recognition of Needs; Specification and Concept. After Bibliographic survey, anthropometric study came to the sketch and the concept of the project. As a result we obtained the first prototype in material available and using the CAD program Solid Edge Insight has been proposed a prototype scanned of the orthosis, setting out proposals and requirements for the development of bracing. The results we obtained two scanned drawings of the prototype and four prototypes in different materials, composed of nine parts (two lateral branches, an ulnar block, three bracelets and three rings), which show a stent mounted articulated. It was observed that the blockade of Ulnar deviation of fingers and allow flexion and extension and the MF\'s wrist. There were adjustments to the drawings in the course of the study, after completion of bench testing. We also found that the orthosis can be used bilaterally, using dorsal round rod in his right hand and left hand use ventral. The stent allows the function of the hand and has easy handling and placement.