Os objetivos deste estudo foram: 1- avaliar a influência dos fatores energéticos e da posição de cabeça, no sentido vertical e horizontal, na qualidade das radiografias cefalométricas e na interpretação dos resultados para diagnóstico e plano de tratamento; 2- verificar as implicações oriundas da determinação de pontos cefalométricos equivocados pela falha no controle de qualidade nas radiografias cefalométricas. Telerradiografias em norma lateral, padronizadas em condições reprodutíveis, foram realizadas em um crânio seco e em um fantoma. Realizou-se simulações de falhas técnicas relacionadas a quilovoltagem, miliamperagem, tempo de exposição e posição do filtro de alumínio, e a modificações horizontais e verticais de 3º, 6º, e 9º do fantoma em relação ao plano sagital mediano e ao plano de Frankfurt, respectivamente. Vinte e seis radiografias cefalométricas foram selecionadas e encaminhadas para seis examinadores (3 ortodontistas e 3 radiologistas), para executarem manualmente a análise cefalométrica de McNamara. ANOVA comparou as medidas de onze variáveis nas 26 análises cefalométricas. Quando ocorreu diferença, aplicou-se o teste de comparações múltiplas de Games-Howell (variâncias heterogêneas) e o de Tukey HSD (variâncias homogêneas), ao nível de probabilidade 5%. Não houve diferenças estatisticamente significantes entre os seis examinadores e entre as onze variáveis estudadas (p > 0,05). Observou-se pouca influência dos fatores energéticos na qualidade das imagens e reprodutibilidade dos pontos cefalométricos estudados. As variações horizontais da posição da cabeça em relação ao plano sagital mediano apresentaram discrepâncias significativas na qualidade da imagem radiográfica para cefalometria. Pontos cefalométricos inadequados comprometeram o diagnóstico, mesmo com examinadores experientes. A interpretação das cefalometrias precisa estar associada com aspectos clínicos, fotografias, modelos gnatostáticos e outras radiografias, para estabelecer o diagnóstico e plano de tratamento. / The aims of this study were to evaluate the influence of energetic factors and head position on the quality of cephalometric radiographs and on their interpretation, and to analyze the consequences of incorrect landmark identification due to errors in quality control in cephalometric radiographs. Standardized lateral cephalographs of a dry skull and a phantom were taken. There were made simulations of technical errors related to kilovoltage, milliampereage, exposition time and position of Al filter, and to horizontal and vertical changes of 3°, 6° and 9° of the phantom in relation to sagital plane and Frankfurt plane, respectively. Twenty-six cephalometric radiographs were selected and 6 examiners (3 orthodontists and 3 radiologists) performed the manual cephalometric analyses of McNamara. ANOVA compared the measurements of 11 variables in the 26 cephalometric analyses. Significant statistically differences were not found among the 6 examiners and among the 11 variables (p > 0.05). Energetic factors had low influence in the quality of the images and on the reproducibility of the cephalometric landmarks. Horizontal variations of head position in relation to sagital plane influenced the quality of cephalometric radiographs. Incorrect cephalometric landmarks compromised the diagnosis, even with experienced examiners. Cephalometry should be complimented by clinical examination, photographs, gnathostatics models and others radiographs to establish diagnosis and treatment.

O propósito do presente estudo foi avaliar, radiograficamente, a relação entre lábios, pogônio mole, maxila, mandíbula e incisivos em indivíduos com perfil facial equilibrado. Foram avaliados 30 brasileiros do gênero feminino, entre 19 e 31 anos de idade, dos quais foram obtidas telerradiografias em norma lateral, na posição natural da cabeça orientada. A análise cefalométrica foi realizada avaliando-se o nariz, os lábios e o pogônio mole em relação à linha vertical verdadeira que passa pelo ponto subnasal (SnV), a maxila e a mandíbula em relação à base do crânio e os incisivos em relação às suas bases ósseas. Os resultados demonstraram que o lábio superior se apresentou ligeiramente à frente da linha SnV, o lábio inferior se posicionou sobre a linha e o pogônio mole atrás da mesma. Já a maxila se apresentou ligeiramente protruída enquanto que a mandíbula encontrou-se bem posicionada em relação à base do crânio, deste modo, a relação maxílo-mandibular se mostrou um pouco aumentada. Embora os incisivos superiores tenham apresentado inclinações normais, os inferiores se encontraram ligeiramente vestibularizados. Foram, também, observadas correlações positivas estatisticamente significativas entre: o comprimento mandibular e a projeção do lábio inferior; a projeção do pogônio duro e a projeção do pogônio mole; a relação maxilo-mandibular e a relação labial no sentido antero-posterior; a projeção dos lábios e a projeção do pogônio mole. Foi observada, ainda, correlação negativa estatisticamente significativa entre: a inclinação do incisivo inferior e a projeção do lábio inferior; a inclinação do incisivo inferior e a projeção pogônio mole. / The purpose of this study was to radiographically evaluate the relations hip between lips, soft pogonion, maxilla, mandible and incisors in individuals with a balanced facial profile. Thirty Brazilian women aged 19 to 31 years were evaluated, from whom teleradiographs (lateral view) were taken in the natural position of the oriented head. The cephalometric analysis was performed evaluating the nose, the lips and the soft pogonion in relation to the vertical line which passes by the subnasal point (SnV), the maxilla and the mandible in relation to the base of the skull and the incisors in relation to their bone bases. The results demonstrated that the upper lip was slightly forward to SnV line, the lower lip was positioned on the line and the soft pogonion was behind the line. The maxilla was slightly protruded, whereas the mandible waswell positioned in relation to the base of the skull, therefore the maxillomandibular relationship was somewhat augmented. Although the upper incisors had normal inclinations, the lower incisors were slightly protruded. Statistically significant positive correlations were also observed between the mandibular length and the projection of the lower lip; the projection of the hard pogonion and the projection of the soft pogonion; the maxillomandibular relationship and the lip relationship in the anteroposterior direction and between the projection of the lips and the projection of the soft pogonion. A statistically significant negative correlation was also found between the inclination of the lower incisor and the projection of the lower lip and between the inclination of the lower incisor and the projection of the soft pogonion.

Objetivo: Com o propósito de contribuir com o diagnóstico ortodôntico realizou-se o presente estudo para verificar a associação existente entre a Avaliação Subjetiva da Altura Facial e as mensurações cefalométricas do Índice de Vert (Análise de Ricketts), Quociente de Proporcionalidade (Análide de Siriwat-Jarabak) e Altura Facial Anterior inferior - AFAi (Análise de McNamara), disponíveis para avaliar padrão esquelético vertical da face de um indivíduo. Métodos: Utilizou-se 174 fotografias faciais padronizadas (87 frontais e 87 laterais) e 87 telerradiografias em norma lateral, correspondente a 46 adultos portadores de perfil facial equilibrado e 41 adultos que não apresentavam equilíbrio do perfil facial. Através do programa de computador (Dolphin 3D® version 11 premium, Dolphin Imaging and Management Solutions, Chatsworth, CA EUA) foram obtidas as mensurações cefalométricas referentes às análises estudadas. Três ortodontistas experientes realizaram a Avaliação Subjetiva da Altura Facial através das fotografias de frente e de perfil, classificando a altura da face em aumentada, normal ou diminuída. Resultados: O teste estatístico Kappa ponderado foi utilizado para avaliar a concordância entre as análises e, os resultados mostraram fraca concordância (<0,40) entre a AFAi de McNamara e a Análise Facial Subjetiva da Altura Facial, tanto em normal frontal (Kappa ponderado = 0,208) como em norma lateral (Kappa ponderado = 0,145). O Índice de Vert da Análise de Ricketts e o Quociente de Proporcionalidade da Análise de Siriwat-Jarabak não apresentaram concordância com a Análise Facial Subjetiva. Conclusão: A AFAi da Análise de McNamara apresentou fraca concordância com a Avaliação Subjetiva da Altura Facial em comparação com as outras análises avaliadas. / Objective: In order to contribute to the orthodontic diagnosis and facial analyses, this study evaluated the association between the Subjective Evaluation of Facial Height and cephalometric measurements of the Vert Index (Ricketts analysis), ratio quotient (Siriwat-Jarabak analysis) and lower anterior facial height LAFH (McNamara analysis), available to evaluate the vertical skeletal pattern of an individuals face. Methods: The sample of this study was composed by 174 standardized facial photographs (87 frontal and 87 lateral) and 87 lateral cephalograms, obtained from 46 adults with balanced facial profile and 41 adults without balance of the facial profile. A computer software (Dolphin 3D® version 11 premium, Dolphin Imaging and Management Solutions, Chatsworth, CA USA) was used for achievement of cephalometric measurements of the analyses investigated. Three experienced orthodontists conducted the Subjective Evaluation of Facial Height by observation of frontal and profile photographs, scoring the facial height as increased, normal or reduced. Results: The weighed Kappa statistics was applied to evaluate the concordance between analyses, and the results revealed weak agreement (k<0.40) between the LAFH of McNamara and the Subjective Evaluation of Facial Height, both in frontal view (weighed Kappa = 0.208) and lateral view (weighed Kappa = 0.145). The Vert index of the Ricketts analysis and the Siriwat- Jarabak ratio quotient did not present concordance with the subjective facial analysis. Conclusion: The LAFH of the McNamara analysis presented concordance with the Subjective Evaluation of Facial Height compared to the other analyses investigated.

O objetivo do estudo foi avaliar as estruturas dentoesqueléticas e tegumentares finais, principalmente, a posição dos incisivos superiores de pacientes submetidos ao tratamento sem extrações, com extrações de 2 pré-molares superiores e 4 pré-molares no tratamento da má oclusão de Classe II, divisão 1. Um grupo de oclusão normal também foi utilizado. A amostra de 120 indivíduos foi dividida em quatro grupos, sendo três grupos experimentais e um grupo controle. O grupo 1 constituiu-se de 30 pacientes (19 feminino e 11 masculino), com idade média inicial e final de 12,38 e 14,95 anos, respectivamente, tratados sem extrações. O grupo 2 constituiu-se de 30 pacientes (17 feminino e 13 masculino), com idade média inicial e final de 12,68 e 15,28 anos, respectivamente, tratados com extrações de 2 pré-molares superiores. O grupo 3 constituiu-se de 30 pacientes (15 feminino e 15 masculino), com idade média inicial e final de 13,10 e 15,55 anos, respectivamente, tratados com extrações de 4 pré-molares. O grupo 4 foi constituído de 30 indivíduos (15 feminino e 15 masculino), com idade média de 14,93 anos e oclusão normal derivado do Burlington Growth Centre, Departamento de Ortodontia da Faculdade de Odontologia, Universidade de Toronto, Canadá. As condições oclusais inicial e final dos grupos experimentais foram avaliadas nos modelos de gesso utilizando o Índice Peer Assessment Rating (PAR), e as variáveis cefalométricas finais da amostra foram obtidas em telerradiografias norma lateral e comparadas pelo teste Análise de Variância (ANOVA). Os resultados demonstraram que, o grupo 3 apresentou comprimento maxilar menor do que aquele dos grupos 1 e controle; padrão de crescimento mais vertical, incisivos superiores e inferiores mais extruídos do que nos outros grupos. Os grupos experimentais apresentaram maxila e mandíbula retruídas em relação ao grupo controle. Os incisivos superiores apresentaram-se semelhantes entre os grupos experimentais, porém mais verticalizados nos grupos 2 e 3 em relação ao grupo controle e os inferiores mais vestibularizados no grupo 1 do que nos três grupos. O trespasse horizontal foi menor nos grupos tratados do que no grupo controle e o trespasse vertical foi menor no grupo 2 em relação aos grupos 3 e 4. Os perfis ósseo e tegumentar mostraram-se semelhantes entre os 4 grupos. Portanto, os três protocolos de tratamento foram capazes de restringir o deslocamento anterior da maxila e apresentaram efeitos semelhantes no componente mandibular, trespasse horizontal e, principalmente, na posição dos incisivos superiores. Além disso, esses grupos demonstraram um ótimo relacionamento entre as bases apicais, sem prejudicar o perfil facial em relação ao grupo de oclusão normal. / The objective of this investigation was to evaluate the posttreatment dentoskeletal and soft-tissue characteristics, mainly, the maxillary incisor position of Class II, division 1 patients treated nonextraction, with two maxillary premolar and with four premolar extraction protocols. A control group of normal occlusion was also employed. The sample of 120 subjects was divided into four groups, three experimental groups and one control group. Group 1 comprised 30 patients (19 girls, 11 boys) with initial and final mean age of 12.38 and 14.95 years, respectively, and treated without extraction. Group 2 comprised 30 patients (17 girls, 13 boys) with initial and final mean age of 12.68 and 15.28 years, respectively, treated with extraction of 2 maxillary premolars. Group 3 comprised 30 patients (15 girls, 15 boys) with initial and final mean age of 13.10 and 15.55 years, respectively, treated with extraction of 4 premolars. Group 4 comprised 30 individuals (15 girls, 15 boys) with a mean age of 14.93 years and with normal occlusion from the Burlington Growth Centre, Orthodontics Department of the University of Toronto Dental School, Canada. The initial and final occlusal features of the experimental groups were evaluated on dental casts by Peer Assessment Rating (PAR) and the final cephalometric characteristics of the sample were obtained in lateral cephalogram and compared using ANOVA. The results demonstrated that the maxillary showed a smaller length in group 3 than in group 1 and control group; greater vertical growth pattern and greater maxillary and mandible incisors extrusion in group 3 than in the other groups. The experimental group showed maxillary and mandible retrusion regarding the control group. The maxillary incisors were similar among the experimental groups; however they showed greater upright position in groups 2 and 3 than in the control group. The mandibular incisor presented greater buccal displacement in group 1 than the three groups. The overjet was smaller in experimental groups than in control group and the overbite was smaller in group 2 than in groups 3 and 4. The hard- and soft- tissue were similar in all groups. Therefore, the three treatment protocols were able to restrict the anterior displacement of the maxillary and were similar regarding the mandibular component, overjet, mainly, the maxillary incisor position. Besides that, these groups showed a satisfatory maxillomandibular relationship without impairing the facial profile regarding the normal occlusion group.

Inaccuracy in landmark identification is regarded as the most important source of error in cephalometry. Better definition of landmarks should therefore contribute to better clinical decisions and research validity. This study primarily comprised of an ex vivo investigation on 50 extracted lower incisor teeth to determine whether radiopaque markers could be utilised to accurately assess lower incisor inclination. Fifty extracted lower incisor teeth were mounted onto a Perspex sheet. Radiopaque markers, manufactured from 1mm wide strips of lead film from used peri-apical radiographs, were attached to the crowns of the mounted teeth. A lateral cephalometric radiograph was taken in accordance to standard radiographic procedures (radiograph A). This showed the true inclination of the teeth. A second radiograph was taken with the roots obscured (radiograph B). Three observers traced the inclinations of the teeth on radiograph B (from incisor edge through the middle of the labio-lingual crown-root junction). The determination was done on two different occasions and the assessments compared with the true inclination. Comparative statistical analysis was applied to the readings and the results indicated that this method compared favourably with other methods to determine incisor inclination. In addition, clinical application of opaque markers to the teeth of patients demonstrated the following: it indicated exactly which tooth was being assessed, provided clear definition of the anatomical crown in the sagittal plane and served as a constant reference point for clinical, study model and cephalometric measurements. decisions and research validity. Opaque radiographic markers on teeth can contribute to more accurate cephalometric measurements in orthodontics, leading to better diagnoses, treatment planning and research validity. / Thesis (MChD (Orthodontics))--University of Pretoria, 2005. / Orthodontics / unrestricted

INTRODUÇÃO: A cefalometria constitui um dos elementos auxiliares de grande importância no diagnóstico e planejamento ortodôntico. Diversos estudos já demonstraram que diferentes etnias apresentam algumas variáveis cefalométricas distintas. Realizar o tratamento ortodôntico tendo como guia outra raça ou etnia requer cuidado. As características próprias do indivíduo e seu padrão de miscigenação devem ser respeitados para suportar o diagnóstico e facilitar o plano de tratamento. OBJETIVO: Determinar os valores médios de normalidade das grandezas cefalométricas relacionadas à análise de Ricketts para jovens brasileiros leucodermas, xantodermas e nipo-brasileiros, com oclusão normal e com bom perfil facial, e compará-los entre si. MATERIAL e MÉTODOS: Foram utilizadas 40 telerradiografias laterais de jovens leucodermas (com idade média de 13,64 anos), 31 de xantodermas (com idade média de 15,63 anos) e 32 de nipo-brasileiros (com idade média de 13,96 anos), provenientes do arquivo da Disciplina de Ortodontia da Faculdade de Odontologia de Bauru Universidade de São Paulo. Os dados obtidos foram avaliados estatisticamente pela análise de variância a 2 critérios (ANOVA a 2 critérios) e análise de covariância (ANCOVA) seguidos do teste Tukey. RESULTADOS: encontrou-se diferença estatística significante (p< 0,05) entre as etnias em 6 das variáveis estudadas: Is-APog, Is.APog, Ii-APog, 6-Ptv, profundidade facial e protrusão labial inferior. Não foi observado dimorfismo entre os gêneros. CONCLUSÕES: A amostra de xantodermas apresentou características bem demarcadas de maior protrusão dos incisivos e protrusão labial, e um mento mais retruído, quando comparada com leucodermas e nipo-brasileiros. / INTRODUCTION: Cephalometry is one of the auxiliary elements with great importance in diagnosis and orthodontic planning. Several studies have shown that different ethnic groups have some distinct cephalometric variables. Do an orthodontic treatment having other race or ethnicity as a guide needs some care. The individual characteristics and miscegenation must be respected to support the diagnosis and facilitate treatment plan. OBJECTIVE: Determine the mean normal values and compare Ricketts cephalometric analysis in whites, xanthoderms and japanesebrazilians with normal occlusion and well-balanced faces. MATERIAL AND METHODS: The sample is composed by 103 lateral cephalograms of young brazilians from Orthodontics Department of Bauru Dental Scholl - University of São Paulo, divided into three groups of both genders: group I: 40 whites; group II: 31 xanthoderms; group III: 32 japanese-brazilians. The data were statistically evaluated by analysis of variance 2 criteria and analysis of covariance, followed by Tukey test. RESULTS: we found statistically significant difference (p <0.05) between ethnic groups in 6 variables: Ui-APOG, Ui.APog, Li-APOG, 6-PTV, facial depth and lower lip protrusion. There wasnt sexual dimorphism. CONCLUSIONS: xanthoderms presented a more retruded chin, incisive more protruded combining with a larger biprotrusion lip, compared with whites and japanese-brazilians.

Introduction: Class II Division 1 malocclusions are characterized by a retrusive mandible and prominent upper incisors. Despite Class II malocclusions being one of the most frequently treated cases in orthodontists' office, there is no uniform consensus in the orthodontic community on the best treatment modality and biomechanical approach to use in treating patients with Class II malocclusions. Purpose: This paper examines the end-of-treatment outcomes of severe Class II Division I malocclusion patients treated with surgical versus non-surgical approaches. Study Design: This is a retrospective study of consecutively treated severe Class II Division I patients at the University of Iowa. Initial and deband lateral cephalometric radiographs were compared between 45 non-surgical and 21 surgical patients. All patients that were debanded between the ages of 13 to 19 years were included. Multivariable regression analyses were used to examine differences in outcomes between treatment groups. Results: Following adjustment for patient level confounders (age, gender, and race), those treated surgically had better end of treatment cephalometric outcomes. Those treated surgically had a more balanced skeletal profile, greater reduction in overjet, and improvement in ANB angle (p Conclusion: Orthodontic treatment in conjunction with orthognathic surgery is a more ideal treatment for patients with severe Class II Division I malocclusion. When treated surgically, a greater amount of overjet can be reduced while keeping lower incisors in a more stable position in bone.

No description available.

Tutankhamun was a Pharaoh of the 18th Dynasty (New Kingdom) in ancient Egypt. Medical and radiological investigations of his skull revealed details about the jaw and teeth status of the mummy. Regarding the jaw relation, a maxillary prognathism, a mandibular retrognathism and micrognathism have been discussed previously. A cephalometric analysis was performed using a lateral skull X-ray and a review of the literature regarding King Tutankhamun´s mummy. The results imply diagnosis of mandibular retrognathism. Furthermore, third molar retention and an incomplete, single cleft palate are present.

Introduction: Untreated obstructive sleep apnea (OSA) has deleterious effects on one's overall health. Recent literature suggests that craniofacial abnormalities, as noted on a lateral cephalometric radiograph (ceph) or clinically by the presence of a posterior crossbite, may be associated with OSA. Literature also suggests that if abnormal ceph measurements are noted or if a patient presents with a posterior crossbite, then further questioning about that patients sleep habits and snoring should be addressed. The primary purpose of this study is to explore any possible associations between ceph measurements, and/or presence of a posterior crossbite with OSA, as determined by the Berlin sleep questionnaire, in the orthodontic population. The second purpose of this research is to outline a part 2 follow-up study through administration of an at home sleep test, the Nox-T3 sleep monitor, to further validate presence of OSA. The overall goal is to see if the combined data from the Berlin score, the clinical presence or absence of a posterior crossbite, and standard orthodontic ceph measurements can increase the predictive value of patients in the orthodontic office who might be suffering from obstructive sleep apnea. Methods: A total of 85 consecutive subjects who were already undergoing records in 5 private practice orthodontic offices around the greater Philadelphia area were recruited for voluntary participation in the study. A Berlin questionnaire, lateral ceph, and any noted presence of a posterior crossbite were collected on all subjects. 12 ceph measurements (SNA, SNB, ANB, Co-A, Co-Gn, A-Na perp, Pg-Na perp, SN-MP, FH-MP, Ba-SN, Wits, and MP-Hyoid) were traced by a second year orthodontic resident. 5 subjects were then selected using a random numbers table and given the Nox-T3 sleep monitor for self-administration to record their sleep for one night. Statistical analyses were run using SAS version 9.2 to evaluate any associations. Results: A total of 76 subjects completed data collection, whereas 9 subjects either failed to report their height, and/or weight, and/or failed to complete the Berlin questionnaire in its entirety thus excluding them from the study. A total of 11, or 14% of subjects scored high on the Berlin, meaning a high risk of suffering from OSA. Of all ceph measurements, the only one that showed a statistically significant association with the high Berlin score was MP-Hyoid (p=0.0033). BMI alone was not found to be associated with the Berlin score (p=0.3712). Presence of a posterior crossbite also did not show any correlation with the Berlin score (p= 0.1000). Conclusions: 1) BMI was not found to be associated with the Berlin score among the orthodontic subject population. 2) MP-hyoid was found to be associated with the Berlin score, at a high level of statistical significance. 3) All other cephalometric measurements, including SNA, SNB, ANB, Co-A, Co-Gn, A-Na perp, Pg-Na perp, SN-MP, FH-MP, Ba-SN, and Wits, failed to show any statistically significant correlation to the Berlin score. 4) Posterior crossbite was not found to be associated with the Berlin Score among the orthodontic subject population. Key words: Obstructive sleep apnea, Berlin sleep questionnaire, cephalometric, posterior crossbite, Nox-T3 sleep monitor, orthodontic population / Oral Biology