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Syfte: Syftet med den här studien var att undersöka följsamheten och reduktionen av det horisontella överbettet vid behandling med van Beek-aktivator genom att jämföra en rekommenderad användningstid av tolv och åtta timmar per dag. Material och metod: Tretton patienter (4 pojkar och 9 flickor) ingick i undersökningsmaterialet med en medelålder på 10,0 år (SD = 0,9). Alla patienter var diagnostiserade med en Angle Klass II-bettavvikelse och behandlades med van Beek-aktivator. Patienterna var randomiserade i två grupper med två olika användningstider (8 timmar och 12 timmar). Följsamheten mättes med hjälp av en mikrosensor (TheraMon®) inbyggd i aktivatorn och det horisontella och vertikala överbettet registrerades efter första, tredje och sjätte månaden. Efter att datan var insamlad gjordes statistisk analys för att påvisa ifall statistisk skillnad fanns mellan grupperna.Resultat: Medelreduceringen i horisontellt överbett i 8-timmarsgruppen var efter sex månader 3,4 mm jämfört med hos 12-timmarsgruppen som var 3,5 mm. Medelanvändningstiden var i 12-timmarsgruppen och 8-timmarsgruppen 8.2 timmar (SD=1,7) och 7,9 timmar (SD=2,6) per dag respektive. Den genomsnittliga användningstiden för samtliga patienter var 8,1 timmar.Slutsats: Rekommendation av åtta timmar var enklare att uppnå jämfört med tolv timmar. Van Beek-aktivatorn var effektiv för korrigering av Angle Klass II-bettavvikelser, ingen klinisk signifikant skillnad i behandlingseffekt observerades mellan de två grupperna. / Aim: The aim of this study was to evaluate the compliance and overjet changes among patients treated with the van Beek activator comparing a twelve- and eight-hours daily wear-time prescription. Material and methods: The study sample consisted of thirteen patients (4 boys and 9 girls) with a mean age of 10.0 years (SD = 0.9). All patients had a Class II malocclusion and were treated with the van Beek activator. Patients were randomly assigned to two groups with a wear-time of twelve and eight hours respectively. Compliance was measured with the aid of a microsensor (TheraMon®) built into the activator and the overjet and overbite were recorded after the first, third and sixth month. Results: The mean decrease in overjet among the 8 hours group after six months was 3.4 mm compared to the 3.5 mm overjet reduction recorded in the 12 hours group. The mean wear-time in the 12 hours group and 8 hours group were 8.2 hours (SD = 1.7) and 7.9 hours (SD = 2.6) per day respectively. The overall mean daily wear-time of all patients in both groups was 8.1 hours. Conclusions: The eight-hours prescription was easier to achieve compared to the twelve-hours. The van Beek activator was effective in Class II correction, no clinically significant difference in treatment effect was observed between the two wear-time prescriptions.

Syfte: Syftet med denna studie var att utvärdera följsamheten och förändringen i det horisontella överbettet hos patienter som behandlas med en van Beek-aktivator, under det första behandlingsåret, genom att jämföra två rekommenderade användningstider; 8 timmar och 12 timmar. Material och metod: Totalt 20 patienter, 9 flickor och 11 pojkar, med en medelålder på 10,0 år, ingick i undersökningsmaterialet. Samtliga patienter diagnosticerades med en Angle Class II-bettavvikelse, och behandlades med en van Beek-aktivator. Patienterna delades slumpmässigt in i två grupper med olika rekommenderade användningstider; 8 timmar och 12 timmar. Följsamhetsnivån mättes med hjälp av TheraMon®, en mikrosensor, inbäddad i aktivatorn. Följsamheten, det horisontella och det vertikala överbettet registrerades efter 3, 6, 9 och 12 månader. Resultat: I båda grupperna observerades en minskning av både det horisontella och vertikala överbettet. Det fanns ingen signifikant skillnad mellan 8- och 12-timmarsgruppen för reduktion av överbetten. Följsamheten var däremot bättre i 8-timmarsgruppen under hela 12-månadersperioden.Slutsatser: En rekommenderad användningstid på 8 timmar per dag visade en högre nivå av följsamhet än 12 timmar, i den aktuella studien. Ingen klinisk signifikant skillnad i behandlingseffekt upptäcktes mellan 8-timmars och 12-timmars rekommenderad användningstid. Följsamhetsnivån är högre under de första 6 månaderna av en behandling och minskar sedan mellan 6-12 månader. / Aim: The aim of this study was to evaluate the adherence and the changes in overjet among patients treated with the van Beek activator during the first year, comparing two wear-time prescriptions; 8 hours and 12 hours. Materials and methods: The study sample consisted of 20 patients, 9 girls and 11 boys, with a mean age of 10.0 years. All patients were diagnosed with a class II malocclusion and were treated with the van Beek activator. The patients were randomized into two groups with different wear-time prescriptions; 8 hours and 12 hours. The level of adherence was measured with the aid of TheraMon®, a microsensor embedded in the activator. The adherence, overjet and overbite were recorded after 3, 6, 9 and 12 months of treatment. Results: In both groups, a reduction of both overjet and overbite was observed. There was no significant difference between the 8- and 12-hour group for overjet and overbite reduction. The adherence, on the other hand, was better in the 8-hour group during the whole 12-month period. Conclusions: A wear-time prescription of 8 hours per day displayed a higher level of adherence than 12 hours in the present trial. No clinically significant differences in treatment effects were detected between an 8-hour and 12-hour wear-time prescription. The level of adherence is higher during the first 6 months of a treatment and is then reduced between 6-12 months.

Significant advances have been made in orthodontics and oral maxillofacial surgery for the diagnosis and treatment of dentofacial deformities. However, compared with bone, the effect of muscles of the craniofacial complex in the development of dentofacial deformities has received little attention. Recently, cellular and molecular studies of the musculoskeletal interactions have been used to investigate the etiology of dentofacial malocclusions. In this study, we tested for relationships that might exist between gene expression of the chromatin modifying enzymes histone deacetylase-4 (HDAC4) and histone acetyltransferase-4 (MYST4) and expression of myosin heavy chain (MyHC) genes and fiber-type percent occupancy (%Occ) in masseter muscle of patients undergoing orthognathic surgery to correct severe dentofacial malocclusions. The diagnostic categories of malocclusion in sagittal and vertical dimensions were: 1) Deep bite-Class II (D2); 2) Deep bite-Class III (D3); 3) Normal bite-Class II (N2); 4) Normal bite-Class III (N3), 5) Open bite-Class II (O2); 6) open bite with Class III (O3). Relative quantities (RQs) of gene expression were determined by reverse transcriptase real time polymerase chain reaction (RT-PCR) in RNA extracts of masseter samples, previously analyzed by immunohistochemistry for %Occ values. By multivariate analysis, RQs of HDAC4 and MYST4 expression did not differ significantly between malocclusion types. However, multiple high positive and negative correlations were found for HDAC4 and MYST4 with MyHC expression and with fiber type %Occ. Significant correlations occurred for HDAC4 with: IIX and neonatal MyHCs respectively in N2 and N3 subjects; fiber types I, I/II and neonatal/atrial %Occ respectively in D2 and N3, D2 and O3 subjects. Further investigations are needed to support evidence of these correlations and determine their significance toward diagnosis, treatment and relapse potential in the correction of dentofacial deformities. / Oral Biology

Introduction: The purpose of this study was to subclassify the types of facial asymmetries present in a pre-surgical dentofacial deformity patient population to determine the prevalence of each subcategory. Associations between the craniofacial characteristics of each asymmetry and pre-surgical Jaw Pain and Function Questionnaire (JPFQ) scores, diagnosis of temporomandibular disorders (TMD), and posterior facial asymmetry (PFA) as determined by nasal septum deviation were analyzed. In addition, the data will aid in the development of a phenomics database to allow for subsequent genotyping and gene expression evaluation from patient saliva and masseter muscle samples that were obtained at the time of corrective orthognathic surgery. Methods: Pre-surgical posterio-anterior (PA) cephalograms, submentovertex (SMV) and panoramic (PAN) radiographs from 92 pre-surgical dentofacial deformity patients at the Department of Oral and Maxillofacial Surgery, University of Lille, France were collected to evaluate facial asymmetry. PAs were traced and analyzed according to the Grummons Simplified Frontal analysis and Ramal Height analysis (Dolphin Imaging). SMVs were analyzed by the refined clinical system of the Ritucci and Burstone analysis proposed by Arnold et al along with original angular measurements for maxillary, mandibular, and nasal septum deviations (ImageJ). PFA was determined by a nasal septum deviation greater than 15 degrees. Lastly, PANs were evaluated visually for condylar pathologies. A comprehensive diagnostic decision tree for facial asymmetry was formulated based upon the current literature for normal variation of landmarks and the study design. Patient diagnosis via the decision tree was compared to visual examination of the appropriate x-rays to verify accuracy. Using this decision tree, patients were classified into subtypes and prevalence of each was calculated to form a phenomics database for future research on genotyping and gene expression. Associations between the subclassifications, mean pre-surgical JPFQ scores, temporomandibular joint (TMJ) clinical examination results (TMD+ or TMD-), and the diagnosis of posterior facial asymmetry (PFA+ or PFA-) were completed. Results: Sixty-two patients were able to fulfill all radiographic requirements to arrive at a diagnosis. Eighteen patients demonstrated facial asymmetry that fell within normal biological variation while the other 44 were diagnosed as having a form of facial asymmetry – Cranial Base Asymmetry: 11 female, 6 male; Non-Condylar Mandibular Asymmetry: 5 female, 3 male; Hemimandibular Elongation: 2 female, 3 male; Maxillary Asymmetry: 3 female, 1 male; Idiopathic Condylar Resorption: 3 female, 1 male; Atypical Asymmetry: 3 female, 1 male; Hemimandibular Hyperplasia: 1 female, 0 male; and Maxillary Base & Mandibular Body Asymmetry: 0 female, 1 male. JPFQ scores for symmetric patients ((x ) ̅= 5.33) and asymmetric patients (x ̅= 4.57) were non-significant overall, however, differences between gender were noted (female symmetric (x ) ̅= 6.13, male symmetric (x ) ̅= 1.33, female asymmetric (x ) ̅= 5.36, male asymmetric (x ) ̅= 3.19). TMD was diagnosed by pre-surgical TMJ examinations and MRIs. Four symmetric patients (3 female, 1 male) were positively diagnosed with TMD while 14 asymmetric patients (11 female, 1 male) also were diagnosed. PFA was diagnosed when nasal septum deviation was greater than 15 degrees – 25⁰ to ≤35⁰: 9 patients; >35⁰ to ≤45⁰: 3 patients; >45⁰: 1 patient. Twenty patients with a positive PFA were asymmetric while the other 8 symmetric. Twenty-one patients with PFA were female while the other 7 were male. Conclusion: A comprehensive diagnostic decision tree for facial asymmetry classification was formulated and validated. With it, it was found that: Females have increased JPFQ scores and clinical diagnosis of TMD versus males. Asymmetric females have decreased JPFQ scores, but increased prevalence of TMD. Presence of PFA does not appear to be a strong influence on development of facial asymmetry but is significantly linked to the presence of TMD. PFA is present in nearly half of all dentofacial deformity subjects. Mandibular asymmetry is most commonly associated with increased JPFQ scores and presence of TMD. However, Hemimandibular Hyperplasia, a particular and less common form of mandibular asymmetry, never associated with TMD. One form of mandibular and mid-facial asymmetry, Atypical Asymmetry, had a relatively high prevalence of TMD. Future directions for this research include continuation of genotypic description of IGF1 and Nodal biologic pathways to determine how gene expression levels in masseter muscle and patient genotypes differ in the eight subclassifications of craniofacial asymmetry compared to the symmetric population. / Oral Biology

Les anomalies de croissance maxillo-faciale résultent de variations du processus normal de croissance. Après les caries, elles représentent les problèmes bucco-dentaires les plus fréquents chez les jeunes et peuvent entraîner des troubles fonctionnels (mastication, phonation, respiration), esthétiques et parfois psychologiques. Le traitement orthodontique vise à corriger les anomalies de croissance maxillo-faciale. L’objectif de cette thèse est de rechercher des facteurs de risque précoces d’anomalies de croissance maxillo-faciale et d’étudier le rôle des facteurs socio-économiques, culturels et géographiques de l’accès au traitement orthodontique en France. Les enfants de la cohorte EPIPAGE, qui avait inclus toutes les naissances survenues entre 22 et 32 semaines d’aménorrhée dans neuf régions françaises en 1997, ont été examinés à 5 ans. Nous avons étudié les relations entre les caractéristiques néonatales et la déformation du palais à 5 ans chez 1711 enfants. Le sexe masculin, le petit âge gestationnel, le petit poids pour l’âge gestationnel et peut-être l’intubation de longue durée sont identifiés comme des facteurs de risque de déformation du palais à 5 ans chez les grands prématurés ; de plus, les enfants avec des déficiences neuro-motrices semblent particulièrement à risque. La cohorte mère-enfant EDEN, a inclus des femmes enceintes en 2002-2003 et leur enfant à la naissance. Nous avons recherché les facteurs de risque précoces de l’occlusion postérieure inversée et de la béance antérieure chez 422 enfants de 3 ans. En plus d’une tétine encore utilisée à 3 ans et de la respiration buccale qui sont des facteurs connus, un nouveau facteur de risque d’occlusion postérieure inversée en denture temporaire est mis en évidence : la prématurité. Enfin, l’étude chez les 5988 enfants et les adolescents de l’enquête sur la santé et la consommation de soins en France réalisée par l’Insee en 2002-2003, enquête transversale sur échantillon représentatif de la population vivant en France, montre que 23% des 12-15 ans ont un traitement orthodontique. En plus du facteur économique, le moindre recours au traitement orthodontique est aussi lié à l’environnement social et culturel moins favorisé de l’enfant, à l’absence de couverture complémentaire et à l’habitation en zone rurale.En conclusion, pour mieux comprendre les inégalités dans le traitement orthodontique, il faudrait en évaluer les besoins en amont. Nous avons étudié des facteurs liés à la présence d’anomalies de croissance maxillo-faciale à des âges très jeunes afin de pouvoir identifier tôt des enfants à risque de ces anomalies. Il est nécessaire de vérifier leur évolution pour savoir si elles sont de réels marqueurs précoces de besoin en traitement orthodontique. / Malocclusions are due to variations of normal process of growth. Besides caries, they are the most common oral problems encountered by children and teenagers. They may lead to oral dysfunction (in chewing, speaking and breathing), esthetic and sometimes psychological issues. Orthodontic treatment aims at correcting malocclusions.The purpose of this thesis is to investigate early risk factors for malocclusions and to analyze the role of socioeconomic, cultural and geographic factors in access to orthodontic treatment in France. In the EPIPAGE cohort study, which included all live births between 22 and 32 weeks of gestation in 9 French regions in 1997, 1711 children were examined at 5 years. We explored the relations between neonatal characteristics and alteration of palatal morphology at 5 years. Male sex, low gestational age, small for gestational age and maybe intubation of long duration were identified as risk factors for alteration of palatal morphology et 5 years in very preterm children; children with neuromotor deficiencies seem particularly at risk. The mother-child EDEN cohort included pregnant women in 2002-2003 and their child at birth. We investigated early risk factors for posterior crossbite and anterior open bite in 422 3-year-old children. In addition to ongoing pacifier sucking habit at 3 years and mouth breathing, which are well-known risk factors, prematurity appears to be a new risk factor for posterior crossbite in temporary dentition. Finally, the French survey on health and care consumption, carried out in 2002-2003 in a representative sample of 5988 children and teenagers, shows that 23% of the 12-15 years old have an orthodontic treatment. Besides the economic factor, the less orthodontic treatment uptake is related to a less privileged social environment, to the absence of supplementary insurance and to living in a rural area.In conclusion, to understand inequalities in orthodontic treatment better, orthodontic treatment need should be evaluated first. We investigated factors related to malocclusions at very young ages, which could help to early identify children at risk. The assessment of how these early malocclusions would evolve is therefore needed in order to control if those malocclusions are indeed early markers for orthodontic treatment need.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Pacientes portadores de deformidades dentofaciais podem relatar dificuldades de mastigação e fala, desordens temporomandibulares, preocupação com a imagem corporal e baixa autoestima. Frequentemente, buscam tratamento orto-cirúrgico pela motivação de obter melhora notável nos aspectos estético, funcional e psicossocial. A evidência atualmente disponível sobre os benefícios na qualidade de vida relacionada à saúde bucal desta modalidade terapêutica ainda não é conclusiva, devido à diversidade de metodologias adotadas entre os estudos existentes, majoritariamente realizados na América do Norte, Europa, Oriente Médio e Ásia. Logo, é essencial utilizar instrumentos específicos para avaliar os efeitos desta modalidade de tratamento também na vida diária dos pacientes brasileiros. O propósito do presente estudo transversal foi determinar o impacto que o tratamento orto-cirúrgico exerce sobre a percepção de qualidade de vida dos pacientes portadores de deformidades dentofaciais, bem como a influência exercida pelo gênero, idade, renda, escolaridade e características da má oclusão, nas quatro etapas inerentes a esta modalidade de tratamento: (1) Inicial; (2) Preparo ortodôntico para a cirurgia; (3) Pós-cirúrgico; e (4) Contenção (pós-tratamento). Duzentos e cinquenta e quatro pacientes foram entrevistados em três importantes centros de atendimento na cidade do Rio de Janeiro. A qualidade de vida foi avaliada pelos questionários OHIP-14 (Oral Health Impact Profile - Short Version) e pelo OQLQ (Orthognathic Quality of Life Questionnaire) em suas versões traduzidas e validadas para o português. A gravidade da má oclusão e autopercepção estética foram avaliadas com base no Índice de Necessidade de Tratamento Ortodôntico (IOTN) e pelo Índice de Estética Dental (DAI). A análise dos dados foi efetuada pelos testes qui-quadrado, Kruskal-Wallis e modelos de regressão binomial negativa múltipla. Os pacientes dos quatro grupos foram semelhantes em relação ao gênero (p = 0,463), escolaridade (p = 0,276) e renda familiar (p = 0,100). Entre os entrevistados houve o predomínio de mulheres, com ensino médio completo e renda familiar entre 2 e 3 salários mínimos, portadores de má oclusão de Classe III de Angle grave. No modelo de regressão binomial negativa ajustado para os fatores gênero, idade, renda familiar e escolaridade, a qualidade de vida aferida pelo OHIP-14 demonstrou que o grupo Inicial sofreu impactos mais negativos do que os grupos Pós-cirúrgico, Preparo e Contenção; o OQLQ indicou que o grupo Inicial sofreu impactos mais negativos do que os grupos Preparo, Pós-cirúrgico e Contenção, nesta sequência. Não foi detectada influência da idade, renda e escolaridade nestes resultados. Foi observado que o gênero feminino sofreu mais impacto negativo na qualidade de vida, principalmente nas dimensões relativas à função e a aspectos sociais. Concluiu-se que os pacientes que finalizaram o tratamento orto-cirúrgico apresentaram como benefícios menores impactos na qualidade de vida específica e relacionada à saúde bucal, melhor autopercepção estética e menor gravidade da má oclusão, em comparação aos pacientes nas etapas pré e pós-cirúrgica e aos pacientes portadores de deformidades dentofaciais em busca de tratamento. / Patients with dentofacial deformities may complain about having trouble chewing and speaking, temporomandibular joint disorders, dissatisfaction with their own appearance and low self-esteem. They frequently seek out orthosurgical treatment motivated by an expectation of a significant aesthetic, functional and psychosocial improvement. Evidence currently available is not yet conclusive about the benefits of orthognathic surgery towards Oral Health-Related Quality of Life (OHRQoL). This is due to a lack of consensus among the various methods used to measure the changes among the existing studies, mainly performed in North America, Europe, Middle East and Asia. Therefore the use of specific tools is important to evaluate the effects of this therapeutic modality on the daily life of Brazilian patients. The aim of this cross-sectional study was to assess the impact of orthosurgical treatment on patients perceptions of their OHRQoL, and the influence of gender, age, socioeconomic status, schooling and occlusal characteristics, at the four stages of this treatment modality: (1) Initial; (2) Pre-surgical orthodontic treatment; (3) Post-surgical; and (4) Retention (post-treatment). Two hundred and fifty-four patients were interviewed at three important local attendance centers in the city of Rio de Janeiro. Quality of life was evaluated by OHIP-14 (Oral Health Impact Profile - Short Version) and OQLQ (Orthognathic Quality of Life Questionnaire) translated and validated into Brazilian Portuguese. The severity of Malocclusion and aesthetic self-perception were assessed by IOTN (Index of Orthodontic Treatment Need) and DAI (Dental Aesthetic Index). Data analysis was performed using Chi-square and Kruskal-Wallis tests and negative binomial regression models. The four groups shared similar make up in terms of gender (p = 0.463), schooling (p = 0.276) and economic status (p = 0.100). Among those interviewed, there was a predominance of women, who had graduated from high school, and with family income of between two and three minimum wages, presenting severe Class III malocclusion. In the negative binomial regression model, adjusted for gender, age, family income and schooling, the OHRQoL evaluated by OHIP-14 demonstrated that the Initial group presented more negative impact than the Postsurgical, Pre-surgical or Retention groups; OQLQ showed that the Initial group suffered more negative impacts than the Pre-surgical, Post-surgical and Retention groups, in this sequence. Any influence of age, family income and schooling was not detected. The female gender showed more negative impact on the OHRQoL, primarily concerning dental function and social aspects. It was concluded that patients who completed orthosurgical treatment presented the benefit of less acute impacts on the OHRQoL, better self-perception of the aesthetic and less severe malocclusion, when compared to patients at pre and post-surgical stages and those individuals not treated for dentofacial deformities.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Pacientes portadores de deformidades dentofaciais podem relatar dificuldades de mastigação e fala, desordens temporomandibulares, preocupação com a imagem corporal e baixa autoestima. Frequentemente, buscam tratamento orto-cirúrgico pela motivação de obter melhora notável nos aspectos estético, funcional e psicossocial. A evidência atualmente disponível sobre os benefícios na qualidade de vida relacionada à saúde bucal desta modalidade terapêutica ainda não é conclusiva, devido à diversidade de metodologias adotadas entre os estudos existentes, majoritariamente realizados na América do Norte, Europa, Oriente Médio e Ásia. Logo, é essencial utilizar instrumentos específicos para avaliar os efeitos desta modalidade de tratamento também na vida diária dos pacientes brasileiros. O propósito do presente estudo transversal foi determinar o impacto que o tratamento orto-cirúrgico exerce sobre a percepção de qualidade de vida dos pacientes portadores de deformidades dentofaciais, bem como a influência exercida pelo gênero, idade, renda, escolaridade e características da má oclusão, nas quatro etapas inerentes a esta modalidade de tratamento: (1) Inicial; (2) Preparo ortodôntico para a cirurgia; (3) Pós-cirúrgico; e (4) Contenção (pós-tratamento). Duzentos e cinquenta e quatro pacientes foram entrevistados em três importantes centros de atendimento na cidade do Rio de Janeiro. A qualidade de vida foi avaliada pelos questionários OHIP-14 (Oral Health Impact Profile - Short Version) e pelo OQLQ (Orthognathic Quality of Life Questionnaire) em suas versões traduzidas e validadas para o português. A gravidade da má oclusão e autopercepção estética foram avaliadas com base no Índice de Necessidade de Tratamento Ortodôntico (IOTN) e pelo Índice de Estética Dental (DAI). A análise dos dados foi efetuada pelos testes qui-quadrado, Kruskal-Wallis e modelos de regressão binomial negativa múltipla. Os pacientes dos quatro grupos foram semelhantes em relação ao gênero (p = 0,463), escolaridade (p = 0,276) e renda familiar (p = 0,100). Entre os entrevistados houve o predomínio de mulheres, com ensino médio completo e renda familiar entre 2 e 3 salários mínimos, portadores de má oclusão de Classe III de Angle grave. No modelo de regressão binomial negativa ajustado para os fatores gênero, idade, renda familiar e escolaridade, a qualidade de vida aferida pelo OHIP-14 demonstrou que o grupo Inicial sofreu impactos mais negativos do que os grupos Pós-cirúrgico, Preparo e Contenção; o OQLQ indicou que o grupo Inicial sofreu impactos mais negativos do que os grupos Preparo, Pós-cirúrgico e Contenção, nesta sequência. Não foi detectada influência da idade, renda e escolaridade nestes resultados. Foi observado que o gênero feminino sofreu mais impacto negativo na qualidade de vida, principalmente nas dimensões relativas à função e a aspectos sociais. Concluiu-se que os pacientes que finalizaram o tratamento orto-cirúrgico apresentaram como benefícios menores impactos na qualidade de vida específica e relacionada à saúde bucal, melhor autopercepção estética e menor gravidade da má oclusão, em comparação aos pacientes nas etapas pré e pós-cirúrgica e aos pacientes portadores de deformidades dentofaciais em busca de tratamento. / Patients with dentofacial deformities may complain about having trouble chewing and speaking, temporomandibular joint disorders, dissatisfaction with their own appearance and low self-esteem. They frequently seek out orthosurgical treatment motivated by an expectation of a significant aesthetic, functional and psychosocial improvement. Evidence currently available is not yet conclusive about the benefits of orthognathic surgery towards Oral Health-Related Quality of Life (OHRQoL). This is due to a lack of consensus among the various methods used to measure the changes among the existing studies, mainly performed in North America, Europe, Middle East and Asia. Therefore the use of specific tools is important to evaluate the effects of this therapeutic modality on the daily life of Brazilian patients. The aim of this cross-sectional study was to assess the impact of orthosurgical treatment on patients perceptions of their OHRQoL, and the influence of gender, age, socioeconomic status, schooling and occlusal characteristics, at the four stages of this treatment modality: (1) Initial; (2) Pre-surgical orthodontic treatment; (3) Post-surgical; and (4) Retention (post-treatment). Two hundred and fifty-four patients were interviewed at three important local attendance centers in the city of Rio de Janeiro. Quality of life was evaluated by OHIP-14 (Oral Health Impact Profile - Short Version) and OQLQ (Orthognathic Quality of Life Questionnaire) translated and validated into Brazilian Portuguese. The severity of Malocclusion and aesthetic self-perception were assessed by IOTN (Index of Orthodontic Treatment Need) and DAI (Dental Aesthetic Index). Data analysis was performed using Chi-square and Kruskal-Wallis tests and negative binomial regression models. The four groups shared similar make up in terms of gender (p = 0.463), schooling (p = 0.276) and economic status (p = 0.100). Among those interviewed, there was a predominance of women, who had graduated from high school, and with family income of between two and three minimum wages, presenting severe Class III malocclusion. In the negative binomial regression model, adjusted for gender, age, family income and schooling, the OHRQoL evaluated by OHIP-14 demonstrated that the Initial group presented more negative impact than the Postsurgical, Pre-surgical or Retention groups; OQLQ showed that the Initial group suffered more negative impacts than the Pre-surgical, Post-surgical and Retention groups, in this sequence. Any influence of age, family income and schooling was not detected. The female gender showed more negative impact on the OHRQoL, primarily concerning dental function and social aspects. It was concluded that patients who completed orthosurgical treatment presented the benefit of less acute impacts on the OHRQoL, better self-perception of the aesthetic and less severe malocclusion, when compared to patients at pre and post-surgical stages and those individuals not treated for dentofacial deformities.

INTRODUCTION Il existe actuellement de nombreuses options esthétiques de traitement pour corriger orthodontiquement les malocclusions dentaires. Le standard de traitement en chirurgie orthognatique est d’utiliser des boîtiers conventionnels fixes. Récemment, une nouvelle technique gagne en popularité en pratique privée : l’utilisation de coquilles d’alignement transparentes comme alternative esthétique. La littérature actuelle sur ce sujet consiste exclusivement de rapports de cas. Ainsi, il semble raisonnable d’affirmer que davantage de recherche est nécessaire sur ce sujet. OBJECTIFS L’objectif principal de cette étude rétrospective est d’évaluer la qualité des résultats obtenus à la suite de traitements combinés d’orthodontie et de chirurgie orthognatique en utilisant le système Invisalign®, en comparaison avec les boîtiers orthodontiques traditionnels. L’objectif secondaire de comparer la durée de traitement entre les deux systèmes. MATÉRIEL/MÉTHODES Quarante-neuf patients ont été recrutés en provenance de deux pratiques orthodontiques privées (24 Invisalign® / 25 contrôles de boîtiers fixes). Les deux groupes étaient initialement similaires, tel que mesuré par le Discrepancy Index de l’American Board of Orthodontics. Les résultats finaux ont été évalués en utilisant l’outil Phase III (Model Grading System) de l’American Board of Orthodontics. RÉSULTATS Les scores moyens de chaque catégorie du Model Grading System étaient supérieurs pour le groupe Invisalign® et une différence significative existait entre les groupes pour les catégories d’alignement, de contacts occlusaux, d’angulation des racines et de score total. Les durées de la préparation pré-chirurgicale et du traitement total se sont révélées plus courtes pour le groupe Invisalign® (p ≤ 0.05). CONCLUSION Invisalign® a produit des traitements combinés d’orthodontie et de chirurgie orthognatique plus courts que les boîtiers traditionnels. Par contre, des scores du Model Grading System supérieurs ont été répertoriés lorsque comparés avec les boîtiers conventionnels, signifiant la production de résultats de qualité inférieure à la technique traditionnelle fixe. / INTRODUCTION Numerous esthetic orthodontic treatment options currently exist to correct dental malocclusions. The gold standard in orthognathic surgery is to use bonded orthodontic brackets. Recently, clear aligners have been proposed as an alternative. The current available literature on this topic consists exclusively of case reports. Therefore, it seems reasonable to assume that further research is needed on this topic. OBJECTIVE The primary objective of this retrospective study aims to evaluate the quality of the outcomes of combined orthodontic and surgical treatments with Invisalign® when compared with conventional orthodontic treatments. The secondary objective is to compare the duration of treatment between Invisalign® and conventional brackets. MATERIAL/METHODS Forty-nine patients were recruited from two orthodontic private practices (24 Invisalign® / 25 bracket controls). Both groups were initially similar, as per the ABO Discrepancy Index. The results were assessed using the ABO Phase III method (MGS). RESULTS The MGS mean scores were consistently higher for Invisalign® and there was a significant difference between the groups regarding alignment, occlusal contacts, root angulations and total score. The duration of pre-surgical preparation and the total treatment time were shorter for the Invisalign® group (p ≤ 0.05). CONCLUSION Invisalign® provided faster combined orthodontic and orthognathic surgery treatment, yet demonstrated inferior quality of results when compared to conventional brackets using the MGS.

Introduction: Since the success of treatment through removable appliances depends mostly of patient cooperation, functional fixed appliances have been widely used in treatment of Class II malocclusion for a huge number of professionals. Objective: The purpose of this study is to analyze the effects of the Forsus Fatigue Resistant Device and to compare the findings with a well-matched group treated with the Mandibular Anterior Repositioning Appliance (MARA) for the correction of Class II malocclusion, and to compare with an untreated Class II malocclusion control group. Methods: The Forsus group was composed of 14 patients. The MARA group was comprised of 18 patients. The untreated control group was composed of 14 patients. Lateral cephalometric radiographs were taken of each subject at the pretreatment (T1) and posttreatment (T2). Posttreatment changes were calculated as T1-T2. Intergroup comparisons regarding treatment changes were performed using repeated measures analysis of variance (ANOVA) followed by Tukeys test. Results: During treatment, the Forsus group showed statistically significant decrease of maxillary protrusion and maxillomandibular sagittal discrepancy in relation to the control group. The MARA group showed statistically significant greater retrusion of maxillary incisors in relation to the Forsus and the control group. Overjet decreased significantly more in the treated groups in relation to the control group. The molar relationship improved significantly more in both treated groups, and both showed more correction than did the untreated control group. Conclusion: The Forsus and MARA associated with fixed appliances effectively correct the Class II malocclusion, mostly by means of dentoalveolar changes and maxillary growth restraint. / Introdução: O sucesso do tratamento da má-oclusão de Classe II com aparelhos funcionais removíveis depende principalmente da cooperação do paciente, portanto, aparelhos funcionais fixos têm sido amplamente utilizados por um grande número de profissionais. Objetivo: Analisar os efeitos do aparelho Forsus e comparar os achados com um grupo tratado com o aparelho MARA, comparando-os com um grupo controle de Classe II não tratada. Métodos: O grupo Forsus foi composto por 14 pacientes. O grupo MARA foi composto por 18 pacientes. O grupo controle foi composto por 14 pacientes. Telerradiografias em norma frontal foram tiradas de cada indivíduo no estágio pré-tratamento (T1) e pós-tratamento (T2). Alterações pós-tratamento foram calculadas como T1-T2. Comparações intergrupo em relação às alterações de tratamento foram realizadas utilizando ANOVA seguido de teste Tukey. Resultados: Durante tratamento, o grupo Forsus demonstrou maior diminuição da protrusão maxilar e da discrepância maxilo-mandibular sagital em relação ao grupo controle. O grupo MARA demonstrou maior retrusão de incisivos superiores em relação aos outros grupos. O overjet diminuiu estatisticamente mais nos grupos tratados do que no grupo controle. Houve melhora na relação molar em ambos os grupos tratados do que o grupo controle. Conclusão: O Forsus e o MARA associados ao aparelho ortodôntico fixo são eficazes no tratamento da má oclusão de Classe II, principalmente por alterações dentoalveolares e restrição de crescimento maxilar.