Background: Arterial allografts are used as vascular conduits in the treatment of prosthetic graft infection. Immunosuppression decreases their rupture risk rate. However, immunosuppression can be unprofitable in florid infection. Previously, we confirmed inhibition of cell-mediated destruction of rat aortic grafts by delayed use of tacrolimus. In this work, we studied the influence of this protocol on the antibody-mediated rejection.

Objectif : Évaluer les effets sur la croissance des maxillaires, ainsi que les effets dentaires, de l'utilisation du Forsus versus celle des élastiques de classe II. Matériel et méthode : Un échantillon de 30 patients a été traité sans extraction et a eu une phase d'alignement préliminaire avec appareillage orthodontique fixe complet. Vingt-trois (23) patients (14 filles, 9 garçons) ont été traités à l'aide de Forsus (âge moyen : 13,4 ans) et 7 patients (4 filles, 3 garçons) ont été traités avec des élastiques de classe II (âge moyen : 14,3 ans). Une radiographie céphalométrique a été prise à la fin de la phase d'alignement, juste avant la mise en place de l'appareil myofonctionnel choisi, et une autre au moment de l'enlèvement de l'appareil (temps de port moyen : 0,5 an). Les radiographies ont ensuite été tracées à l'aveugle et 17 mesures ont été sélectionnées pour évaluer l'effet des appareils sur les maxillaires (ANS-PNS, SNA, SNB, ANB, Go-Pg, Ar-Go, Co-Gn, axe Y, Ar-Gn, Ar-Go-Me, FMA, POF/FH, PP/FH, B-Pg(PM), 1/-FH, 1/-/1, /1-PM). Un questionnaire pour évaluer le confort face à leur appareil a été remis aux patients à environ la moitié du temps de port estimé. Résultats : Il n'y a aucune différence statistiquement significative entre les deux traitements sur la croissance du maxillaire (ANS-PNS p = 0,93, SNA p = 0,12). De façon générale, il n'y a pas non plus de différence significative entre les deux traitements sur la croissance de la mandibule (Ar-Gn p = 0,03, SNB p = 0,02 et pour les 6 autres mesures p > 0,05). Pour la composante dento-alvéolaire, les deux traitements proclinent les incisives inférieures et rétroclinent les incisives supérieures, le Forsus causant une plus forte rétroclinaison des incisives supérieures (1/-FH p = 0,007, /1-PM p = 0,10). Pour les changements angulaires des plans, le Forsus cause de manière significative une augmentation de l’inclinaison du plan occlusal (POF/FH p = 0,001). Pour le questionnaire sur l'évaluation du confort, il n'y a pas de différence entre les deux traitements en ce qui concerne la gêne face aux activités quotidiennes (p = 0,19). L'hygiène est plus facile avec les élastiques (p = 0,03). Le sommeil n’est perturbé par aucun des appareils (p =0,76). La différence entre le groupe «élastiques» et le groupe «Forsus» pour le confort en général n'est pas significative (p = 0,08). Conclusions : Le but de l’étude étant de vérifier l’efficacité des élastiques de classe II bien portés versus celle des Forsus, on peut conclure que leurs effets sont relativement similaires sur les maxillaires. Cependant, le Forsus cause de manière statistiquement significative une augmentation de l'angle du plan occlusal et une rétroclinaison plus importante des incisives supérieures. / Objective : To compare the effects on jaw growth of using Forsus Springs versus class II elastics. Material and Method : A sample of 30 patients was treated non extraction. Following a preliminary alignment phase with full fixed braces, 23 patients (14 girls, 9 boys) were treated with Forsus and 7 patients (4 girls, 3 boys) were treated with elastics (mean age : 14,3yo). Average wearing time : 0,5 y. Cephalometric radiographs were taken at the end of the alignment phase and at the end of the functional phase. Radiographic measurements were taken to assess the effects of both appliance types (ANS-PNS, SNA, SNB, ANB, Go-Pg, Ar-Go, Co-Gn, axe Y, Ar-Gn, Ar-Go-Me, FMA, POF/FH, PP/FH, B-Pg(PM), 1/-FH, 1/-/1, /1-PM). Questionnaires to assess comfort with the appliances were given to the patients approximately halfway through treatment. Results : No statistically significant differences in maxillary growth (ANS-PNS p = 0,93, SNA p = 0,12) or mandibular growth (Ar-Gn p = 0,03, SNB p = 0,02 and for the other 6 measurements p > 0,05) were noted between groups. Both treatments proclined lower incisors and retroclined upper incisors, with the Forsus causing more retroclination of the upper incisors (1/-FH p = 0,007, /1-PM p = 0,10). Forsus caused a statistically significant steepening of the occlusal plane (POF/FH p = 0,001). With respect to patient comfort, there was no statistically significant difference between the two treatments, although maintaining oral hygiene was easier in the elastics group (for daily activities p = 0,19, oral hygiene p = 0,03, sleep p =0,76, general comfort p = 0,08). Conclusions : The aim of this study being to assess the effectiveness of well worn class II elastics versus the effectiveness of Forsus, we can conclude that their effects are relatively similar on the maxillary bones. However, Forsus cause a statistically significant increase of the inclination of the occlusal plane and greater retroclination of upper incisor.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Histopathologic examination of the tumor microenvironment demonstrates the presence of a vast repertoire of infiltrating lymphocytes and antigen presenting cells (APC’s). Recent studies establish a strong correlation between the tumor microenvironment cell composition and prognostic value in terms of cell type, location and ratio, referred to as a tumor’s immunoscore. More specifically, the relationship between T regulatory (Treg) cell to T effector (Teff) cell percentage predominates as a mechanism of tumor immune evasion. Further investigation of the factors influencing the development of Treg and Teff cells is therefore warranted. Gammainterferon‐inducible lysosomal thiol reductase (GILT) acts to influence antigenic processing and presentation by MHC class II cells, ultimately impacting lymphocyte development. Evaluation of the role of GILT expression in MHC class II+ APC’s with respect to Treg and Teff cell development in primary melanoma lesions, to our knowledge, has not been reported. Therefore our investigation focuses on elucidating a plausible relationship between GILT presence and Treg to Teff cell ratio. The aim of our study is to examine a possible association between GILT expression in APC’s and Treg:Teff cell ratio. We hypothesized GILT expression in melanoma cells would result in a decreased Treg to Teff ratio or an enhanced T cell‐mediated response. Our study included 17 de‐identified primary melanoma specimens previously stained and scored for Treg, Teff, CD8, MHC class II and GILT. Scoring was performed through identification of four areas per specimen with highest Treg and Teff cell density. These four areas were then averaged with ± standard deviation (SD). With use of landmark association, these four areas were identified and scored for MHC class II and GILT in APC’s and tumor cells with consideration to presence/absence, intensity and frequency of staining. Statistical significance was not reached relative to our hypothesized relationship of a decreased Treg to Teff cell ratio in the presence of GILT+ MHC class II. Similarly, we did not reach statistical significance when comparing individual cell types to GILT, MHC class II and GILT + MHC class. In our study, we were unable reach statistical significance relative to our proposed correlation between MHC class II and GILT presence leading to a decreased Treg to Teff cell ratio or enhanced T‐cell mediated immune response. A major limitation of our study included the small sample size leading to a probable type II error, prompting the need for further investigation of the factors influencing the Treg to Teff cell ratio within the melanoma tumor microenvironment on a larger scale.

Abstract Background: Type 1 diabetes (T1D) is a multifactorial autoimmune disease. Its incidence in Europe is continuously rising. The highest T1D risk is associated with HLA (human leukocyte antigen) class II genes. HLA class II molecules play a key role in regulation of immune response. They contribute to the selection of T cell repertoire by presenting antigenic peptides to the CD4+ T lymphocytes. HLA class II expression is controlled by regulatory module that is situated 150 - 300 base pairs upstream of the transcription- initiation site in all HLA class II genes. Polymorphisms in this region are linked to some autoimmune diseases. There were identified several promoter alleles (named QAP) in the HLA DQA1 gene promoter region. Most of the polymorphisms appear to be conserved within haplotype. Individual QAP alleles may have a different promoter strength by which they influence expression of HLA DQA1 gene alleles. Promoter strength can be modulated by DNA methylation. Aims:Our aim was to define methylation profile of HLA DQA1 promoters and determine the mRNA expression of individual alleles of HLA DQA1 gene in T1D patients. The mRNA expression level of HLA DQA1 gene alleles was determined using quantitative PCR. Methods: 30 diabetic pacients (age range 21 to 76 years), were included in this pilot...

Introduction: At our post-genomic era the studies of epigenetic regulation constitutes one of the tools for understanding the function of genes. Epigenetic regulation can directly control the temporal and spatial gene activity or silencing. The molecular basis of these regulations are DNA bases modifications, chromatin remodeling and RNA interference. At the same time, these mechanisms have a special way of transferring genetic information to subsequent generations called epigenetic inheritance. It has been proven epigenetic deregulation of certain genes as cause for many disease. For this reason, the study of epigenome HLA genes seems particularly important because these genes play a fundamental role in regulating the immune system. Aims: The aim of this work is to create a description of epigenetic modifications within families. It is an analysis of histone modifications and DNA methylation in the promoter region of the gene HLA DQA1. The aim was also to compare the differences in epigenetic modifications between alleles and compared the differences in these modifications between generations. The results will be compared with the analysis of the level of expression of the gene HLA DQA1. Methods: From collected peripheral blood of donors were isolated DNA, RNA, and leukocytes. DNA was used for...

A faringite estreptocócica desencadeada pelo Streptococcus pyogenes pode resultar em uma série de doenças humanas e complicações como a febre reumática (FR) em indivíduos predispostos não tratados. A FR é uma doença autoimune que afeta mais de 20 milhões de crianças em países em desenvolvimento. A proteína M presente na membrana do S. pyogenes representa o maior fator de virulência da bactéria, e é objetivo de estudos para o desenvolvimento de uma vacina contra essa patologia. Atualmente mais de 200 tipos de proteínas M foram descritos na literatura e a sua porção Cterminal é conservada entre os diferentes tipos. Desenvolvemos um protótipo de vacina que compreende 55 resíduos de aminoácido da porção C-terminal, denominado StreptInCor. Neste trabalho analisamos a resposta humoral e celular específica contra o peptídeo sintético StreptInCor, usando camundongos transgênicos portadores de HLA de classe II humanos DR2, DR4, DQ6 e DQ8. O protocolo de imunização consistiu em administrar 50 g do StreptInCor adsorvido em 300 g de hidróxido de alumínio nos dias 0 e 14. Os grupos controles foram injetados com salina nas mesmas condições. O soro obtido no 28º dia foi testado por ensaio imunoenzimático (ELISA) para verificarmos a presença de anticorpos contra o StreptInCor e os esplenócitos destes animais, obtidos nessa data, foram utilizados para ensaios de proliferação celular na presença do StreptInCor. Testes de segurança foram efetuados e não observamos reação cruzada contra a miosina cardíaca e após 12 meses de acompanhamento, amostras de tecidos desses animais foram submetidas à análise histológica. Em conclusão não verificamos indícios de reações autoimunes nos animais imunizados com o StreptInCor e os resultados obtidos mostram a capacidade do StreptInCor em desencadear uma resposta imune, duradoura e segura em camundongos portadores de moléculas HLA de classe II / Streptococcal pharyngitis triggered by Streptococcus pyogenes throat infection can result in rheumatic fever (RF) and rheumatic heart disease (RHD) in untreated susceptible individuals. RF is an autoimmune disease that affects more than 20 million children in developing countries. M protein is the major factor of virulence of the bacteria, and it has been studied to develop a vaccine. Currently more than 200 M protein types have been described and its Cterminal domain is conserved in many different serotypes. We developed a vaccine epitope (StreptInCor) composed by 55 amino acid residues of the Cterminal portion of the M protein. In the present work we analyze the ability of the StreptInCor of induce immune response in HLA class II transgenic mice. The transgenic mice harboring the HLA Class II DR2, DR4, DQ6 and DQ8 were immunized subcutaneously with 50 g StreptInCor adsorbed onto 300 g of aluminum hydroxide gel on days 0 and 14. Control groups were immunized with vehicle (Saline) in same conditions. The sera were obtained on day 28 and tested by ELISA to verify the presence of antibodies. The specific cellular immune response was evaluated by proliferation assay using splenocytes. No cross reaction with cardiac myosin were observed. Tissue samples from immunized mice followed by 12 months were analyzed in order to verify if StreptInCor induces some histological damage. No autoimmune or deleterious reactions were observed. In conclusion our results indicate that StreptInCor Induces a good and prolonged and safe immune response in HLA class II transgenic mice

Verificando a importância da morfologia dos arcos dentários no tratamento ortodôntico, a proposta deste estudo foi avaliar e comparar as formas e dimensões de arcos de 30 indivíduos com oclusão normal e 30 com má-oclusão de Classe IIdivisão 1ª, geradas a partir de três categorias de pontos de referência. Foram demarcados nos modelos de estudo: os pontos médios das faces vestibulares dos dentes (1ª categoria de pontos); pontos no rebordo alveolar, perpendiculares aos anteriores e sobre a junção muco-gengival (2ª categoria de pontos); e pontos mesiais e distais das superfícies oclusais dos dentes. Todos os pontos foram digitalizados e convertidos automaticamente para o sistema de coordenadas x, y e z pela máquina de medidas tridimensional da Mitutoyo (modelo Crysta-Apex/C). Um software, especialmente desenvolvido para este trabalho, criou um conjunto de pontos de referência virtuais (3ª categoria de pontos) a partir dos pontos mesiais e distais das superfícies oclusais previamente demarcados nos modelos, que representou o fundo dos canais de encaixe de braquetes. Além disso, gerou curvaturas por meio de equações matemáticas (parábola, elipse, catenária e função beta) que se ajustaram, pelo método dos mínimos quadrados, às 3 diferentes categorias de pontos de referência, e mediu as dimensões transversais dentárias e dos rebordos alveolares. A seleção da equação matemática que melhor descreveu cada categoria de pontos de referência foi realizada por meio de avaliação do menor valor do erro médio. A curvatura do rebordo selecionada foi deslocada sobre o eixo y até tangenciar o ponto médio virtual do incisivo central mais anterior, simulando a inserção de um arco ortodôntico, e foram medidas as distâncias entre esta curvatura e os pontos médios virtuais dos outros dentes. Todos os dados foram organizados em tabelas de acordo com a categoria dos pontos de referência, os arcos (superior ou inferior) e o tipo de oclusão. Verificou-se que todas as dimensões transversais dentárias e dos rebordos superiores, e posteriores inferiores são estatisticamente maiores nos indivíduos com oclusão normal do que nos indivíduos com má-oclusão de Classe II; e que as distâncias transversais dos rebordos alveolares são estatisticamente maiores do que as dentárias. Quanto às formas dos arcos, a catenária, seguida da elipse, foram as que melhor descreveram as suas curvaturas, independentemente da categoria de pontos e do tipo de oclusão. As outras formas, como a parábola e a gerada pela função beta, foram observadas com baixo percentual de ocorrência. As formas dos arcos não caracterizaram diferencialmente os tipos de oclusão e as 3 categorias de pontos de referência estudadas. Praticamente todos os pontos médios virtuais apresentaram-se internamente posicionados em relação à curvatura do rebordo alveolar quando esta foi deslocada até o ponto médio virtual do incisivo central mais vestibularizado, sendo encontrados valores estatisticamente maiores no arco superior dos indivíduos com má-oclusão de Classe II-divisão 1ª. Este dado revela maior tendência a vestibularização dos dentes superiores nestes indivíduos, quando o rebordo alveolar é utilizado como guia para a construção do arco ortodôntico, embora as diferenças entre os grupos não nos pareçam clinicamente importantes. / Given the importance of dental arch morphology in orthodontic treatment, we have evaluated and compared, based on three categories of reference points, the shapes and dimensions of the arches of 30 subjects with normal occlusion and 30 subjects with Class II, division 1 malocclusions. .The points marked on the study casts were: the middle points of the buccal surfaces of teeth (first category of points); points on the alveolar ridge, perpendicular to those of the first category and on the mucogingival junction (second category of points); and mesial and distal points of the occlusal surfaces of the teeth. All points were digitized and automatically converted to the x, y and z system of coordinates by a three-dimensional measurement machine (Mitutoyo - Crysta-Apex/C model). A computer software program especially developed for our study created a set of virtual reference points (third category of points) based on the distal and mesial points on the occlusal surfaces previously marked on the casts, which represented the most inner point of the bracket slot. In addition, the software generated curvatures using mathematical equations that were adjusted to the three categories of reference points by the method of minimum squares, and measured the transversal dimensions of teeth and alveolar ridges. Selection of the mathematical equation that best described each category of reference points was performed by evaluating the smallest value for the mean error. The selected ridge curvature was shifted on the y-axis until it became tangential to the virtual middle point of the most anterior central incisor, simulating the insertion of an orthodontic arch, and the distances between this curvature and the virtual middle point on the other teeth were measured. All data were tabulated according to reference point category, arch (upper or lower), and type of occlusion. We observed that all transversal dimensions of teeth, upper ridges and lower posterior ridges were statistically greater in subjects with normal occlusion than in subjects with Class II malocclusions; and that the transversal distances of the alveolar ridges were statistically greater than those of the teeth. As to arch shape, the catenary, followed by the ellipse, were the shapes that best described the arch curvatures, regardless of reference point category and occlusion type. The other shapes, such as the parabola and the shape generated by the Beta function, were observed at lower frequencies. The arch shapes did not differentially characterize the several types of occlusion or the 3 reference point categories studied. Practically all virtual middle points were located internally to the curvature of the alveolar ridge when this curvature was shifted up to the virtual middle point of the most buccaly projected central incisor, and the subjects with Class II division 1 malocclusion were found to have statistically greater values for the upper arch. This observation reveals a greater trend for buccally projected upper teeth in these subjects when the alveolar ridge is used as a guide to construct the orthodontic arch, although the differences observed between the groups do not seem to be clinically important.

Recursos ortopédicos e ortodônticos, utilizados de forma associada, têm se mostrado uma opção terapêutica eficiente no tratamento da má oclusão de Classe II, 1ª divisão desde que o paciente ainda apresente um potencial de crescimento favorável. Entretanto, as alterações nas relações esqueléticas, dentárias e tegumentares só podem ser consideradas satisfatórias caso permaneçam estáveis. Assim, este trabalho teve o propósito de avaliar cefalometricamente e por meio de modelos de estudo, a estabilidade das alterações decorrentes do tratamento com o aparelho Bionator de Balters, seguido do aparelho fixo, após um período médio de 10 anos. O grupo experimental compreendeu 23 pacientes que foram avaliados em três fases: inicial (T1), final (T2) e longo tempo pós-tratamento (T3). Foram avaliadas as telerradiografias em norma lateral (inicial, final e longo tempo pós-tratamento), totalizando 69 telerradiografias, e foram mensurados 69 modelos de estudo, avaliados nas fases previamente descritas, através do índice PAR. Também calculou-se a diferença entre o PAR inicial e o PAR final, a % de melhora obtida com esta terapia e a % de recidiva, ambas através do índice PAR. As variáveis analisadas foram comparadas por meio da análise de variância (ANOVA) para medidas repetidas e o teste de comparações múltiplas de Tukey. A terapia estudada não propiciou alterações no desenvolvimento maxilar. Observou-se um aumento na protrusão mandibular, bem como um maior incremento no comprimento efetivo da mandíbula. A relação maxilomandibular foi corrigida, notou-se uma melhora na convexidade facial, com a diminuição do ângulo ANB. Alterações significantes no padrão de crescimento craniofacial não foram observadas. Verificou-se, através da variável FMA e no período de longo tempo pós-tratamento, uma rotação do plano mandibular no sentido anti-horário. O posicionamento vertical da maxila (SN.PP) também não se alterou. Os incisivos superiores sofreram lingualização e retrusão. Os primeiros molares superiores mostraram um pequeno aumento no sentido vertical semelhante ao fisiológico, que ocorre pelo processo de flutuação normal. Em contrapartida, os incisivos inferiores sofreram vestibularização e protrusão. Os primeiros molares inferiores, por sua vez, apresentaram um deslocamento no sentido vertical (extrusão) e horizontal (mesialização), contribuindo, assim, para a correção da má-oclusão de Cl II. O tratamento também foi efetivo em corrigir os respasses, horizontal e vertical, bem como a relação molar. O ângulo nasolabial não foi afetado pelo tratamento, mostrando que os aparelhos ortopédicos não afetam substancialmente esta variável. Além disso, é de suma importância, ressaltarmos que, as alterações obtidas, com o tratamento realizado, permaneceram estáveis no período de longo tempo pós-tratamento; demostrando, dessa maneira, a efetividade da terapia selecionada. Finalmente, na análise dos modelos de estudo, os valores do índice PAR sofreram uma redução estatisticamente significante e permaneceram estáveis no período de longo tempo pós-tratamento. A porcentagem de melhora obtida com esta terapia foi de 81,78% e a de recidiva foi de 4,90%. Esses dados refletem que o Bionator de Balters, associado ao aparelho fixo, é uma efetiva alternativa para o tratamento da má-oclusão de Cl II, 1ª divisão. / Orthopedic and orthodontic approaches, used in an associated way, are being considered an efficient therapeutic option for the treatment of the Class II, division 1 malocclusion when the patient still presents a favorable growth potential. However, changes in skeletal, dental and soft tissue relationships only can be considered satisfactory if they remain stable. This study aimed to evaluate, cephalometrically and in dental casts, the stability of the changes resulting from the treatment with the Balters Bionator followed by the fixed appliances, after a mean period of 10 years. The experimental group comprised 23 patients who were evaluated in three stages: initial (T1), final (T2) and long-term posttreatment (T3). A total of 69 lateral cephalograms (initial, final and long-term posttreatment) were evaluated and also 69 dental casts were measured, in the stages previously described, using the PAR index. Furthermore, the difference between initial PAR and final PAR, the percentage of obtained improvement with the therapy and the percentage of relapse were calculated, using the PAR index. Evaluated variables were compared by the analysis of variance (ANOVA) for repeated measures and Tukey test. The studied therapy did not provide changes in maxillary development. An increase in mandibular protrusion, as well as a greater increase in effective length of the mandible, was observed. The maxillomandibular relationship was corrected, and an improvement in the facial convexity was observed, with a decrease of the ANB angle. Significant changes in craniofacial growth were not observed. The analysis of the FMA variable and of the long-term posttreatment revealed a rotation of the mandibular plane in a counterclockwise direction. The vertical positioning of the maxilla (SN.PP) also did not change. The maxillary incisors presented a palatal inclination and retrusion. The maxillary first molars showed a small increase in the vertical direction, similar to the physiological one, which occurred by the normal fluctuation process. In contrast, the mandibular incisors presented a buccal inclination and protrusion. The mandibular first molars showed a displacement in the vertical (extrusion) and horizontal (mesial) direction, which contributed to the correction of the Class II malocclusion. The treatment was also effective in correcting the overbite and overjet, and the molar relationship. The nasolabial angle was not affected by treatment, showing that orthopedic appliances did not significantly affect this variable. Finally, the analysis of the dental casts showed that the values of the PAR index presented a statistically significant reduction and remained stable at the long-term posttreatment. The percentage of improvement obtained with this therapy was of 81.78% and the percentage of relapse was of 4.90%. These data denote that Balters Bionator associated to the fixed appliances is an effective alternative for the treatment of the Class II, division 1 malocclusion.

O objetivo do presente estudo foi determinar os parâmetros morfológicos, faciais e dentários, que devem ser utilizados como referência pelo profissional, ortodontista e cirurgião, para indicação do tratamento ortodôntico-cirúrgico em pacientes com deformidades dentofaciais do Padrão II. Foram selecionados 40 pacientes brasileiros, com crescimento finalizado, 26 do gênero feminino e 14 do masculino, com ângulo de convexidade facial maior que 12º e exposição gengival no sorriso igual ou menor a 3 mm. Foram excluídos os indivíduos xantodermas e melanodermas ou aqueles que já se submeteram a qualquer cirurgia facial. Foram obtidas fotografias extrabucais de frente, de perfil e do sorriso, fotografias intrabucais frontal e laterais direita e esquerda, modelos de gesso e telerradiografias do perfil facial de todos os pacientes. Toda essa documentação foi digitalizada e os arquivos enviados para 30 professores de cursos de Pós-graduação em Ortodontia. Os avaliadores foram solicitados a determinar, em uma lista de fatores relacionados ao diagnóstico ortodôntico, os que eles consideravam de extrema, moderada ou pequena/nenhuma importância na indicação da cirurgia ortognática. Posteriormente, deveriam avaliar os arquivos com as documentações ortodônticas para classificar a estética facial (agradável; aceitável; desagradável) e a melhor opção de tratamento (tratamento ortodôntico compensatório; tratamento ortodôntico-cirúrgico; nenhum tratamento) para cada paciente da amostra. Foram obtidas as medidas das variáveis da análise facial numérica do perfil nas fotografias do perfil facial, da sobressaliência e da sobremordida nos modelos de gesso, das inclinações dos incisivos superiores e inferiores, além do tipo facial, nas telerradiografias do perfil. Testou-se, então, a associação entre cada uma das variáveis acima, além da idade e do gênero, e a indicação do tratamento ortodôntico-cirúrgico e, a partir das variáveis que apresentaram associação, estabeleceu-se uma equação matemática que permite prever a probabilidade de indicação da cirurgia para pacientes Padrão II. Os fatores considerados de extrema importância na indicação da cirurgia ortognática, por pelo menos 50% dos avaliadores, em ordem decrescente de importância, foram os seguintes: estética facial, assimetria facial, convexidade do perfil facial, proporção entre os terços faciais médio e inferior, comprimento da linha queixo-pescoço, idade, exposição gengival no sorriso, projeção anterior do mento, exposição dos incisivos em repouso e sobressaliência. As variáveis que apresentaram associação com a indicação do tratamento ortodôntico-cirúrgico foram a estética facial, o ângulo de convexidade facial total, a sobressaliência e a inclinação do incisivo superior (1.PP). O modelo matemático proposto para prever a porcentagem de indicação de cirurgia ortognática em pacientes com deformidades dentofaciais do Padrão II inclui a estética facial, a sobressaliência e o ângulo de convexidade facial total. A equação visa prover o clínico de uma ferramenta auxiliar na decisão do tratamento dos pacientes Padrão II, principalmente nos casos limítrofes. / The aim of the present study was to determine the morphological parameters, facial and dental, that may be used as references by the professional, either orthodontist or surgeon, to indicate compensatory orthodontic treatment or orthodontic-surgical treatment to patients with Class II dentofacial deformities. Forty brazilian leucoderma patients have been selected, 26 female and 14 male, all of them with growth finished, convexity facial angle higher than 12° and gingival exposure at smile equal or less than 3mm. It has been excluded the ones who have gone through facial surgery. Extrabucal photographs at the frontal, profile and smile views and intrabucal at the frontal, right lateral and left lateral views, plaster casts and lateral cephalometric radiograph have been taken of all patients. This documentation was digitalized and the archives sent to 30 post-graduation course orthodontic teachers of different parts of the country. The appraisers were asked to determine, in a list of factors related to orthodontic diagnosis, the ones they considered of extreme, moderate, little or no importance at the indication of orthognathic surgery. Subsequently, they evaluated the archives with the orthodontic documentation to classify the facial esthetic (pleasant, acceptable, and unpleasant) and the best treatment option (orthodontic compensatory treatment; orthodontic-surgical treatment; no treatment) to each patient of the sample. The measurements of the variables of the numerical facial analysis of the profile have been obtained at the photographs of the facial profile, the overjet and overbite at the plaster casts, and the inclination of the upper and lower incisors and the facial type at the lateral cephalometric radiograph. Then, the association between each of the variables mentioned above, age and gender, and the indication of the orthodontic-surgical treatment were tested. From the variables that showed association, a mathematic equation that allowed to foresee the indication of surgery to patients with Class II dentofacial deformities was established. The factors considered of extreme importance to indicate orthognathic surgery for at least fifty percent of the appraisers, in decreasing order of importance were: facial esthetics, facial assimetry, convexity of the facial profile, proportion between medium and lower facial thirds, length of the chin-neck line, age, gingival exposure at smile, chin anterior projection, incisor exposure at rest and overjet. The variables that showed association with the indication of orthodontic-surgical treatment were: facial esthetics, total facial convexity angle, overjet and upper incisor inclination (1.PP). The mathematic model proposed to foresee the percentage of indication of orthognathic surgery to patients with Class II dentofacial deformities includes facial esthetics, total facial convexity angle and overjet. The equation aims to provide the clinicians with an auxiliary tool at the treatment decision of the patients with Class II dentofacial deformities, especially at borderline cases.

O Objetivo neste estudo prospectivo foi avaliar as mudanças dento-esqueléticas decorrentes do tratamento da má oclusão de Classe II e retrognatismo mandibular, realizado em duas fases de tratamento (ortopédica com aparelho de Herbst e ortodôntica com aparelho fixo pré-ajustado). As telerradiografias em norma lateral, de 17 adolescentes brasileiros consecutivos, foram obtidas no início (T1), final da FASE ORTOPÉDICA (T2), primeiros 13 meses da FASE ORTODÔNTICA (T3) e término da FASE ORTODÔNTICA (T4). As diferenças entre as variáveis cefalométricas (análise de Pancherz) foram analisadas estatisticamente. Os resultados mostraram que de T1 a T4, do total da projeção para anterior da maxila, 42% aconteceram de T1 a T2, 40,3% de T2 a T3 e 17,7% de T3 a T4. 48,2% do crescimento mandibular expressaram-se de T1 a T2 e 51,8% de T2 a T4, no entanto com desaceleração do crescimento de T2 a T3, para logo retomar um crescimento significativo, expressando os 36,7% até T4. A relação molar de classe II e o aumento da sobressaliência que apresentavam os pacientes no início do tratamento foram corrigidos idealmente. Em T4, todos exibiam oclusão normal estável, com boa relação molar e sobressaliência adequada, atingindo os objetivos do tratamento. O plano oclusal que de T1 a T2 sofreu rotação horária, de T2 a T3 retornou às características iniciais, que se mantiveram estáveis até T4. A inclinação do plano mandibular, que descreve o tipo facial, não sofreu alterações em nenhum tempo de observação. Com base nestes resultados pode-se concluir que as mudanças caracterizaram diferencialmente as duas fases de tratamento, sendo que na fase I houve um maior incremento do crescimento mandibular e mudanças dentárias que sobrecorrigiram a má oclusão. A recidiva parcial das mudanças dentárias observada na fase II, não comprometeu as metas ideais do tratamento. O tipo facial foi preservado. / The aim of this prospective study was to assess the dento-skeletal changes in the treatment of Angle Class II, division 1 malocclusion with mandibular retrognathism, realized in two phases (Phase I: Herbst appliance, Phase II: pre-adjusted fixed appliance). Lateral cephalograms of 17 consecutively adolescents were taken at the beginning (T1), at the end of the ORTHOPEDIC FASE (T2), first thirteen months of the ORTHODONTIC FASE (T3) and at end of the ORTHODONTIC FASE (T4). Differences among the cephalometric variables (Pancherz analysis) were statistically analyzed. The results exhibited that from T1 to T4 from the overall maxillary forward growth, 42% happened from T1 to T2, 40,3% from T2 to T3 and 17,7% from T3 to T4. From the overall mandibular forward movement, 48,2% happened from T1 to T2 and 51,8% from T2 to T4, meanwhile with growth slowdown from T2 to T3. The molar Class II relation and the excessive overjet were ideally corrected. At T4, all patients showed stable normal occlusion reaching the objectives of the treatment. The oclusal plane, that from T1 to T2 rotated clock-wise, from T2 to T3 returned to the initial position and remain stable until T4. Mandibular plane inclination, that caracterizes facial type, did not change at any time during the treatment. Based on these results it can be concluded that the changes characterized differently each phase of the treatment: during Phase I there were larger increase of mandibular growth and dental changes that overcorrected the malocclusion. The partial relapse observed in Phase II of treatment did not jeopardize the ideal goals of the treatment. The facial type was preserved.