A ATM pode ser afetada por lesões que alteram sua morfologia e comprometem sua função, levando o cirurgião, algumas vezes, a ter a necessidade de ressecá-la e reconstruí-la. A reconstrução dos defeitos ósseos articulares, congênitos ou adquiridos, é um desafio para o Cirurgião Buco-Maxilo-Facial, podendo ser realizado com materiais aloplásticos, que excluem a necessidade de área doadora, minimizando a morbidade. Entre estes destacamos as próteses totais da articulação temporo-mandibular, estudados até sua forma e composição atual e que possibilitou o estabelecimento de protocolos bem definidos para sua utilização. Destacamos a prótese de estoque da W. Lorenz, com componentes de alta tecnologia e indicações precisas que possibilita grande melhora clínico e funcional. Este estudo avaliou clínico e funcionalmente 15 pacientes tratados no período de oito anos, demonstrando que apesar da melhoria funcional evidente observada, em especial para os casos de anquilose em ATM, ainda muitos estudos e acompanhamento devem ser realizados para se estabelecer, ao longo do tempo, se estas próteses suprem de forma eficiente e duradoura a fisiologia estomatognática ideal. / The TMJ can be affected by injuries that alter its morphology and compromise its normal function, leading the surgeon, sometimes, to have the need to resect it and rebuild it. The reconstruction of the bone articular defects, congenital or acquired, which has been a challenge for the maxillofacial surgeon can be achieved by using aloplastic materials. The use of aloplastics materials precludes the need for a donor area, minimizing the morbidness. Among these, we highlight the temporo-mandibular joint total prosthesis, studied until achieving its current form and composition, and which enabled the establishment of clear protocols for its use. Among these, we highlight the W.Lorenz prosthesis with high technology and specific details that enable a large clinical and functional improvement. This study evaluated important clinical and functional aspects observed in 15 patients treated over a period of eight years, showing that despite the clear functional improvement, particularly observed in cases of TMJ ankylosis, many more studies and monitoring should be conducted to establish, especially in the long term, that these prosthesis supply the stomatognathic system with an effective and durable physiology.

Este estudo retrospectivo teve como objetivo comparar os efeitos esqueléticos, dentários e tegumentares do tratamento com Aparelho de Protração Mandibular (APM) em conjunto com o aparelho fixo em pacientes adolescentes e adultos com má oclusão de Classe II. A amostra foi composta por telerradiografias pré e póstratamento de 23 adolescentes (idade inicial média de 11,75 anos) e de 16 adultos (idade inicial média de 22,41 anos). Testes t (P < 0,05) foram empregados para comparação dos grupos. Os adultos apresentaram menor quantidade de alterações esqueléticas. Com relação às alterações dentárias, os adultos apresentaram menor inclinação lingual dos incisivos superiores; menor extrusão dos incisivos inferiores; menor extrusão dos molares superiores e inferiores; menor mesialização dos molares inferiores; e menor retrusão do lábio superior em comparação aos adolescentes. / The aim of this retrospective study was to compare the skeletal, dental, and soft tissue effects of the Mandibular Protraction Appliance (MPA) treatment in adolescent and adult Class II malocclusion patients. The sample comprised pretreatment and posttreatment cephalograms of 23 adolescents (mean pretreatment age 11.75 years) and 16 adults (mean pretreatment age 22.41 years). The groups were compared with t tests, at P < 0.05. The amount of skeletal changes was smaller in the adult group. Adults showed smaller maxillary incisors lingual tipping, mandibular incisor and molar and maxillary molar extrusion and mandibular molar mesialization. Additionally, adults also showed greater upper lip retrusion as compared to adolescents.

Desde os primórdios da Medicina, a grande preocupação do profissional era ser humanista, com conhecimento cultural, sociológico, familiar, psicológico e espiritual do seu paciente. Durante a primeira metade do século XX, houve uma verdadeira explosão de novas técnicas operatórias e de evoluções no campo tecnológico, principalmente durante e logo após as duas grandes guerras mundiais. Novas especialidades, dentre essas a Cancerologia e suas subdivisões, iniciaram técnicas próprias de tratamento cirúrgico. Desde então, os tratamentos impulsionaram a realização de novos métodos de reconstrução dos defeitos produzidos pelas cirurgias, cada vez mais invasivas e mutiladoras. Portanto, além do diagnóstico e tratamento das enfermidades, começou a existir a preocupação com o resultado destes, como o tipo de contribuição e resultados funcionais para o paciente. Nas últimas décadas, houve a necessidade de avaliar a Qualidade de Vida (QV) destes pacientes frente aos tratamentos realizados. As neoplasias malignas de cabeça e pescoço, pela própria localização anatômica, podem acarretar alterações significativas em funções vitais relacionadas à alimentação, comunicação e interação social dos indivíduos afetados. Objetivo: Avaliar a qualidade de vida dos pacientes com neoplasias malignas avançadas de cavidade oral submetidos a operações radicais com intenção curativa, comparando um grupo de pacientes submetidos à reconstrução funcional de mandíbula com um grupo de pacientes nos quais esta reconstrução não foi efetuada. Material e métodos: 47 pacientes matriculados na Seção de Cirurgia de Cabeça e Pescoço do Hospital do Câncer (HCI-INCa), portadores de carcinoma espinocelular (CEC) de cavidade oral, em estádios III e IV, foram submetidos ao tratamento cirúrgico com mandibulectomia segmentar e radioterapia complementar. Todos foram submetidos ao teste de Qualidade de Vida após o tempo mínimo de seis meses do tratamento cirúrgico. A maioria tinha como sitio anatômico da lesão primária mucosa jugal (49%), seguido do rebordo gengival (33%). As avaliações dos dados colhidos foram analisadas utilizando valores médios, medianas, desvios padrões, frequências simples e percentuais. A avaliação foi feita comparando os tipos de reconstrução: pacientes submetidos a mandibulectomia sem reconstrução funcional da mandíbula (Grupo 1) e com reconstrução funcional da mandíbula (Grupo2). O teste aplicado foi o da Universidade de Washington (UW-QOL). Resultados: Inicialmente, foram selecionados 183 pacientes, contudo em apenas 47 (25,7%) pacientes foi possível a realização da entrevista, sendo estes a amostra para o estudo. A maioria dos pacientes do grupo selecionado era do sexo masculino, total de 39 homens (82,9%). A idade média foi de 64,4 anos (25-94 anos). A maioria dos pacientes apresentava estadiamento clínico IV (83%), foram submetidos à radioterapia adjuvante (95,4%). Treze (27,65%) pacientes receberam reconstrução funcional da mandíbula (grupo 2). A média do escore obtido após a avaliação dos questionários foi de 64,6 (50 a 86,83), a média do escore do Grupo 1 foi de 65 e do Grupo 2 foi de 63,1. Os piores escores foram encontrados nos quesitos deglutição ( Grupo 1 escore de 54,13 e Grupo 2 escore de 53,92) e mastigação (Grupo 1 escore de 25 e Grupo 2 escore de 23,08). Não houve diferenças estatisticamente significativas em nenhum quesito quando comparamos os dois grupos. Pacientes com estadiamento clínico III apresentaram a variável idade na data da entrevista mostrou significância clínica e estatística no domínio dor (p=0,049), evidenciando que pacientes com mais de 60 anos relatavam melhor escore do que os com idade inferior a 60 anos na data da entrevista. A situação conjugal foi estatisticamente associada à qualidade de vida no domínio saliva (p=0,045) e clinicamente, nos domínios aparência e ombro. Pacientes com estadiamento clínico III apresentaram clinicamente melhores escores do que os com estádio IV, evidenciando significância estatística no domínio recreação (p = 0,034). Os pacientes com mais de dois anos de tempo transcorrido entre a cirurgia e a entrevista apresentaram melhores escores de qualidade de vida dos que os com menos de dois anos, com significância estatística para os domínios dor (p=0,032), recreação (p=0,034), fala (p=0,046), paladar (p=0,009), ansiedade (p=0,011) e escore composto. Pacientes com menos de 2 anos de tratamento apresentaram pior escore composto, único quesito com significância estatística entre os grupos (p=0,023). Conclusão: Não houve diferenças estatisticamente significativas nos domínios de Qualidade de Vida entre os dois grupos estudados (com reconstrução óssea versus sem reconstrução óssea), pacientes entrevistados 2 anos ou mais após o tratamento apresentaram escores superiores (p=0,023), único dado com diferença estatisticamente significativa / Since the beginning of Medicine, the major concern of the professional was to be humanist, having cultural, sociological, family-related, psychological and spiritual knowledge of his patient. During the first half of the twentieth century there was an explosion of new surgical techniques and developments in the technological field, especially during and after the two world wars. New specialties, among these the Oncology and their subdivisions initiated proper techniques of surgical treatment. Since then the treatments have boosted the implementation of new methods of reconstruction of defects produced by surgery, increasingly invasive and mutilating, therefore, in addition to the diagnosis and treatment of diseases, came into being the concern about the outcome of these, such as the type of contribution and functional results for the patient. Over the last decades there was a need to assess the Quality of Life (QL) of these patients compared to the treatments performed. Malignant neoplasms of the head and neck, by their own anatomical location, may entail significant changes in vital functions related to feeding, communication and social interaction of the affected individuals. Objective: Assessing the quality of life of patients with advanced malignant neoplasms of the oral cavity undergoing radical operations with curative interaction, comparing a group of patients undergoing functional reconstruction of the jaw with a group of patients in whom this reconstruction was not performed. Material and methods: A total of 47 patients enrolled in the Head and Neck Surgery Section of the Cancer Hospital (HCI-INCA). Carriers of squamous cell carcinoma (SCC/CEC) of the oral cavity, in stages III and IV., were submitted to surgical treatment with segmental mandibulectomy and complementary radiotherapy. All were submitted to the Quality of Life test after a minimum period of six months from the surgery. Most had the anatomical site of primary buccal mucosa (49%), followed by gingival border (33%). The assessment of the data collected was analyzed using averages, medians, standard deviations, simple frequencies and percentages. The evaluation was made by comparing the types of reconstruction: patients undergoing mandibulectomy without functional reconstruction of the jaw (Group 1) and functional reconstruction of the jaw (Group 2). The test used was the University of Washington (UW-QOL). Outcome: Initially, 183 patients were selected, but with only 47 (25.7%) patients the interview was possible, which are the sample for the study. Most of the selected group of patients were male, total 39 men (82.9%). The average age was 64.4 years (25-94 year-old). Most of the patients had clinical stage IV (83%), underwent adjuvant radiotherapy (95.4%). Thirteen (27.65%) patients had functional reconstruction of the mandible (Group 2). The mean score obtained after the evaluation of the questionnaires was 64.6 (50 to 86.83), Group 1\'s average score was 65 and Group 2 was 63.1. The worst scores were found in swallowing (Group 1 score of 54.13 and Group 2 score of 53.92) and chewing questions (Group 1 score of 25 and Group 2 score of 23.08). There were no statistically significant differences in any question when we compare the two groups. Patients with clinical stage III presented a variable age at the interview showed clinical and statistical significance in the pain domain (p = 0.049), showing that patients older than 60 years reported better score than under the age of 60 years at the interview. Marital status was statistically associated with quality of life in the saliva domain (p = 0.045) and clinically in the fields appearance and shoulder. Patients with clinical stage III showed clinically better scores than those with stage IV, showing statistical significance in the recreation area (p = 0.034). Patients with more than two years of time between surgery and the interview have better quality of life scores than those with less than two years, with statistical significance for the pain domain (p = 0.032), recreation (p = 0.034 ), speech (p = 0.046), taste (p = 0.009), anxiety (p = 0.011) and composite score. Patients younger than 2 years of treatment had worse composite score, only question statistically significant between groups (p = 0.023). Conclusion: There were no statistically significant differences in the areas of quality of life between the two groups (with bone reconstruction versus without bone reconstruction), patients interviewed two years or more after treatment had higher scores (p = 0.023), only data showing a statistically significant difference

Este estudo retrospectivo teve como objetivo comparar os efeitos esqueléticos, dentários e tegumentares do tratamento com Aparelho de Protração Mandibular (APM) em conjunto com o aparelho fixo em pacientes adolescentes e adultos com má oclusão de Classe II. A amostra foi composta por telerradiografias pré e póstratamento de 23 adolescentes (idade inicial média de 11,75 anos) e de 16 adultos (idade inicial média de 22,41 anos). Testes t (P < 0,05) foram empregados para comparação dos grupos. Os adultos apresentaram menor quantidade de alterações esqueléticas. Com relação às alterações dentárias, os adultos apresentaram menor inclinação lingual dos incisivos superiores; menor extrusão dos incisivos inferiores; menor extrusão dos molares superiores e inferiores; menor mesialização dos molares inferiores; e menor retrusão do lábio superior em comparação aos adolescentes. / The aim of this retrospective study was to compare the skeletal, dental, and soft tissue effects of the Mandibular Protraction Appliance (MPA) treatment in adolescent and adult Class II malocclusion patients. The sample comprised pretreatment and posttreatment cephalograms of 23 adolescents (mean pretreatment age 11.75 years) and 16 adults (mean pretreatment age 22.41 years). The groups were compared with t tests, at P < 0.05. The amount of skeletal changes was smaller in the adult group. Adults showed smaller maxillary incisors lingual tipping, mandibular incisor and molar and maxillary molar extrusion and mandibular molar mesialization. Additionally, adults also showed greater upper lip retrusion as compared to adolescents.

OBJECTIVE: The objective of this study is to determine the earliest time point in growth when a difference in mandibular shape of dolichocephalic and brachycephalic subjects is distinguishable. MATERIALS & METHODS: 11 dolichocephalic and 14 brachycephalic subjects were selected using lateral cephalograms from the Forsyth/Moorrees Twin Study using a method described by Rocky Mountain Orthodontics. 23 landmarks outlining the mandible were identified on the lateral cephalograms of each subject from their earliest age (5-8 years) to their latest (16-18 years) using TPSdig software. The 2 dimensional coordinates for each landmark were then exported to TPSUtil. From TPSUtil, the TPS data was then converted to a .csv file in Microsoft Excel and imported into MorphoJ for analysis. Primary morphometric analysis consisted of generalized Procrustes analysis, principal component analysis, and discriminant function analysis. RESULTS: The first 5 principal components for both facial types accounted for the majority of the variance. Discriminant function analyses were not significant for any phenotype or age group pairing, suggesting that the overall shape difference was too small to be detected between groups and over time starting at age 7. A plot of the Procrustes coordinates for the brachycephalic group versus the dolichocephalic group revealed that there were differences in shape between the two phenotypes, but this difference was statistically insignificant. CONCLUSIONS: The mandible increases in size with age, with minimal change in shape. Mandibular shape is established by the age of 7. The difference in mandibular shapes of the two phenotypes was not statistically significant.

OBJECTIVES: The objective of this research is to evaluate variation of mandibular arch forms at different heights and to determine if there is any correlation between occlusal arch and sub-gingival arch forms. METHODS: 44 subjects were selected based on the inclusion criteria and their CBCTs then were imported to Mimics software (Materialise NV, Belgium) and traced. Each tooth was sliced midsection at 4 different heights: Occlusal, CEJ, Apex and 5mm apical to the apex. At occlusal level the midpoint of the crown was calculated mesiodistally as well as buccolingually. Subsequently, midpoints between the buccal and lingual plates were located for every tooth between and including the first molars. The points were connected forming 4 splines, which then were exported to Geomorph software (cran.r-project.org, Geomorph package, Dean Adams author, Iowa State 2015) for shape statistical analysis. RESULTS: The variation in the arch form among subjects is significantly smaller in the Occlusal and CEJ level. The variation at apical and basal bone levels are higher than the variation at CEJ and occlusal levels. However, variation between apical and basal bone levels are minimal. CONCLUSIONS: Mandibular dental arch form demonstrate more variation apically. It may be concluded that dental arch form variation should be considered when using standardized arch forms for different patients. The subgingival arch forms cannot be predicted from occlusal arch form. Occlusal arch shape and form may not be an indication of basal bone arch form. More information needed for detection of correlation between occlusal arch and sub-gingival arch forms.

Master of Science / Most studies of condylar movement are based on the movement of an arbitrary condylar point. As the condyle is a 3-dimensional body which undergoes complex rotations and translations in function, the movement of one point in the vicinity of the condyle may not accurately represent condylar movement. The aims of this investigation were to determine in human subjects, during open-close and excursive jaw movements, the movement patterns of arbitrary and anatomical condylar points; and whether the trajectory of a single selected point can accurately reflect the movement of the condyle. In 44 subjects, condylar point movements were recorded with an opto-electronic tracking system (JAWS3D), which recoded the position of three light-emitting diodes attached to each dental arch. The primary point, selected to represent movement of the condyle, was 15 mm medial to the palpated lateral condylar pole, parallel to the Frankfort horizontal plane. Additionally, four points were selected along orthogonal axes in the sagittal plane, and four in the horizontal plane: each was 5 mm from the primary point. In two subjects, the mandibular condyles were imaged by computerised tomography (CT) and the lateral and medial poles, most superior, anterior and posterior points of their condyles were selected. The trajectories of each point were compared for each subject for the mandibular movements listed above. Variability in both path form and dimension was noted between the subjects for all mandibular movements. For example, in an open-close mandibular movement the condylar point translation varied in the antero-posterior direction between 1.8-22.8 mm, and in the supero-inferior direction between 4.5-12.1 mm. For each subject, the pathway of each point was different in form and dimension from that subject’s other condylar points for the open-close, and ipsilateral lateral mandibular movements. For the open-close movement, in only four of the 44 subjects were the arbitrary point traces similar in form within a subject; and the tracings of each subject’s condylar points showed, on average, a 3.2 mm difference in maximal horizontal (i.e. antero-posterior) translation and 2.9 mm in maximal vertical (i.e. supereo-inferior) translation. For contralateral lateral mandibular movements, the path form and dimension in the sagittal plane of the condylar points were similar within a subject; however the lateral component showed variability in path length for the different points within a subject. The pathways of the condylar points for a protrusive movement displayed the most similarity within a subject, with an average of 0.4 mm variation in maximal horizontal or vertical displacement between each subject’s arbitrary condylar points’ tracings. The anatomical condylar points of the two subjects showed variability between and within each subject. For these two subjects the trajectories of the arbitrary condylar points moved in directions similar to the anatomical points of all movements except for the ipsilateral lateral mandibular movement, where in one subject, the arbitrary condylar points moved posteriorly, inferiorly and laterally whereas the anatomical points moved anteriorly, inferiorly and laterally. There is much variability in both form and dimension for mandibular condylar movement between human subjects. There is also considerable variability within subjects in the form and dimension of condylar point movement, whether arbitrary or anatomical, depending on the point selected. By inference therefore, a single condylar point cannot accurately reflect the movement of the mandibular condyle, except perhaps for a protrusive mandibular movement. Multiple mandibular points are therefore required to describe the motion of the condyle. In an ipsilateral lateral mandibular movement, for example, an arbitrary point may move in a completely different direction to the mandibular condyle, and so anatomically derived condylar points should be utilised to assess accurately condylar movement.

Typescript. Bibliography: leaves 131-167.

Purpose: To define initial hard and soft tissue convexity necessary for profiles to consistently improve after mandibular advancement and to assess if pre-surgical lower incisor inclination (IMPA) affects profile change. Methods: 20 general public, 20 orthodontists, and 20 oral surgeons used a Likert scale to rate attractiveness of before and after treatment profiles of mandibular advancement patients. Spearman’s correlation tested for relationships between amount of profile change and varying ANB, profile angle and pre-surgical IMPA. Wilcoxon test compared extraction and non-extraction profile changes. Results: There was a tendency for inverse correlations between profile change and profile angle, but was not statistically significant any of the 3 groups. There was a tendency for positive correlations between profile change and ANB, but was considered significant only for orthodontists. Orthodontists, oral surgeons and the general public found profiles consistently improved when profile angles were ≤159º, ≤158º and ≤157º, respectively. Orthodontists and oral surgeons found profiles consistently improved when ANB angles were ≥5.5º and ≥6.5º, respectively. Profile worsening increases 2.6 to 5.0 times when profile angles exceeded thresholds, and 4.5 to 7.9 times when ANB angles were less than thresholds. No difference in IMPA or profile change in extraction and non-extraction groups. Conclusion: Extractions are not predictive of a greater surgical profile change. Pre-treatment profile angles <160º and ANB >6º are necessary for consistent improvements after surgery. / October 2006

Thesis (Ph. D.)--University of Hong Kong, 2009. / Includes bibliographical references (leaves 163-189). Also available in print.