Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 4 uppsatser.

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

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.

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.

Orientador: Renato Mazonetto / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-06T22:49:48Z (GMT). No. of bitstreams: 1 Boeck_EloisaMarcantonio_D.pdf: 4044156 bytes, checksum: 43213737beb9ec37bba6ab6317e749b5 (MD5) Previous issue date: 2005 / Resumo: O tratamento de eleição para indivíduos adultos que apresentam maloclusão de Classe 11 com deficiência mandibular tem sido o tratamento ortodôntico em conjunto com a cirurgia ortognática. O objetivo deste estudo teve por finalidade avaliar, por meio da cefalometria, a influência das mudanças dentárias e esqueléticas promovidas pelo tratamento ortodôntico pré-cirúrgico e cirúrgico em indivíduos portadores de maloclusão de Classe 11, com deficiência mandibular, submetidos à cirurgia ortognática para avanço mandibular, pela técnica de osteotomÍa sagital bilateral do ramo mandibular. Para o presente trabalho foi selecionada uma amostra de 15 pacientes leucodermas, adultos, do gênero feminino. Para cada paciente, foram analisadas 3 telerradiografias, em norma lateral, tomadas pré-tratamento ortodôntico (ti), pré-cirúrgico imediato (t2) e pós-cirúrgico de no mínimo 6 meses (t3), totalizando 45 telerradiografias. Os traçados foram feitos pelo método manual e, os pontos foram digitalizados utilizando o software Dentofacial Planner Plus (2.02). Os resultados mostraram que os valores de SNB aumentaram de 75,6° para 78,6°. As medidas de BNP e PGNP, também, aumentaram de -12,7mm para -7,7mm e de­12,7mm para -6,6mm, respectivamente. As medidas de SNPM alteraram de 38,7° para 38,2°. Para o ANB foi observado redução de 3,23°, passando de 8,1° para 4,9°. Houve diminuição nos valores de AOBO em 6,3mm, cuja variação foi de 7,6mm para 1,3mm e, nos valores do OJ que reduziu significantemente (5,7mm), variando de 9,Omm para 3,3mm. Foi concluído que o tratamento ortodôntico pré-cirúrgico «h-ti) promoveu mudanças dentárias e esqueléticas mínimas e variáveis no resultado final. Já o tratamento cirúrgico (t3-t2) promoveu mudanças esqueléticas significativas, principalmente nas grandezas relacionadas diretamente à mandíbula (SNB, BNP, PGNP e SNPM) ou indiretamente a ela (ANB, AOBO, e OJ) / Abstract: The treatment to Class 11 adult individuals with mandibular deficiency has been the orthodontic treatment combined with orthognatic surgery. Therefore, a study was conducted to evaluate, through cephalometric analysis, the influence of dentoalveolar decompensation in class 11 patients submitted to orthodontic and surgical treatment for mandibular advancement, by bilateral osteotomy of the mandibular ramus. A sample of fifteen leucoderm adult female patients female were selected for the study. Three cephalometric radiographs of each patient, taken previously to the orthodontic treatment (tI), previously to surgery (t2) and after at least 6 months postoperatively (t3), were analyzed in a total of 45 roentgenograms. The tracings were made through the manual method and the points were digitalized using the software Dentofacial Planner Plus (2.02). The results showed that values of SNB increased from 75,6° to 78,6°. The measures of BNP e PGNP reduceded from -12,7mm to -7,7mm and -12,7mm to -6,6mm, respectively. For the ANB angle a redution of 3,23° was observed from 8,1° to 4,9°. Likewise, there was diminution in values of AOBO in 6,3mm, with variation from 7,6mm to 1,3mm and, the values of OJ had greater reduction (5,7mm), changed from 9,Omm to 3,3mm. It has been concluded that the pre surgical orthodontic treatment promoted minimal and variable dental and skeletal changes in the final result. The surgical treatment caused significant skeletal changes especially in the measurements related to the mandible (SNB, BNP, PGNP and SNPM) or indirect1y to it (ANB, AOBO and OJ) / Doutorado / Ortodontia / Doutor em Radiologia Odontológica

Este estudo teve como objetivo avaliar as alterações dentoesqueléticas e tegumentares do aparelho Twin-block por meio de 42 terradiografias em norma lateral que foram obtidas em duas épocas, T1 antes do tratamento e T2 ao final do tratamento ortopédico de 21 jovens brasileiros, de ambos os gêneros, com idade média de 10,5 anos (mínimo: 9,25 anos; máximo: 12,5 anos) portadores de má oclusão de Classe II com retrognatismo mandibular tratados com este aparelho na Disciplina de Ortodontia da Faculdade de Odontologia de Bauru, Universidade de São Paulo (FOB-USP) e comparados a três amostras com as mesmas características tratadas com os aparelhos ortopédicos Bionator (22 jovens, com idade média de 10,42 anos, mínimo: 8,08 anos; máximo: 12,58 anos) e Herbst (22 jovens, com idade média de 10,48 anos, mínimo: 8,00 anos; máximo:12,75 anos) a um grupo controle de Classe II (24 jovens, com idade média de 9,97 anos, mínimo: 8,33 anos; máximo: 11,67 anos), sem tratamento; num total de 178 telerradiografias em norma lateral. Todos os pacientes se encontravam no mesmo estágio de maturação das vértebras cervicais (início: CVMSII; final: CVMSIII). ANOVA, teste de Tukey e teste t pareado foram aplicados. Os resultados mostraram que todos os aparelhos melhoraram a relação maxilomandibular, as relações dentárias, diminuindo a severidade da má oclusão de Classe II, porém com maiores efeitos esqueléticos nos grupos Twin-block e Bionator, com maior protrusão mandibular e crescimento mandibular, corpo e ramo, respectivamente, e mais efeitos dentoalvelares no grupo Herbst com significante vestibularização e protrusão dos incisivos inferiores. / This study had as aim to assess the dentoskeletal and soft tissue effects of the Twin-block appliance by means of 42 lateral cephalometric radiographs obtained in T1, before treatment, and T2, at the end of the orthopedic treatment, of 21 Brazilian subjects of both genders, mean age of 10.5 years, minimum: 9.25 years; maximum: 12.5 years with Class II malocclusion associated to a mandibular retrognathism treated in the Orthodontic Discipline at Bauru Dental School, University of Sao Paulo and compared to three samples with the same features with the functional appliances, Bionator (22 subjects, 10.42 years, minimum: 8.08 years; maximum:12.58 years), Herbst (22 subjects, 10.48 years; minimum: 8.00; maximum:12.75 years) and an untreated Class II control group (24 subjects, 9.97 years, minimum: 8.33 years; maximum: 11.67 years) in a total of 178 lateral cephalometric radiographs. All patients were in the same cervical vertebral maturation stages (initial: CVMSII; final: CVMSIII). Analysis of Variance (ANOVA) , Tukey test and pared t test were applied. The results showed that all appliances corrected the maxillomandibular relationship, dental relationships reducing the Class II malocclusion severity with more skeletal effects, significant mandibular protrusion, mandibular growth, body and ramus, with Twin-block and Bionator, respectively, and more dentoalveolar effects with Herbst appliance, with significant protrusion and vestibular inclination of the lower incisors.

Introduction: Velopharyngeal inadequacy (VPI) may result in inappropriate oral/nasal coupling during the production of speech sounds, resulting in unwanted nasal resonance and/or nasal air emission. Orthognathic surgeries such as maxillary and/or mandibular advancements are also known to change skeletal and muscular structures resulting in changes affecting velopharyngeal closure (VPC). Although many studies have reported on the effect of maxillary advancement surgery on VPI for patients with cleft lip and palate, the effect of mandibular advancement on VPI has not been studied at length. The purpose of this study was to elucidate the effect of temporary prosthetic mandibular advancement on velopharyngeal function. Methods: Fourteen subjects (7 males, 7 females) with no history of craniofacial abnormalities or speech disorders were recruited. The mean age was 35 years (range = 26-60). Acoustic nasalance measurements were obtained during nasal sentences and during sentences without nasal consonants in two conditions; normally, and while wearing an elastic mandibular advancement (EMA) appliance to advance the mandible by 13mm. In addition, subjects were asked to produce five repetitions of the sentence "Ten men came in when Jane left" while recordings were obtained with a videoendoscopy/phototransducer system that sensed the amount of light passing through the velopharyngeal orifice. The endoscope and fiber optic light were inserted through the subject's middle nasal meatus and positioned above the velum. The phototransducer fiber was extended through the velopharyngeal port into the upper oropharynx to detect light passing through the orifice as the velopharyngeal mechanism opened and closed. Individual subject's outcomes with and without the EMA appliance were analyzed statistically using paired t-test for Nasalance test, and one-way ANOVA/independent samples t-test for phototransducer test. Results: Nasalance did not deteriorate, but significantly decreased for the ‘nasal’ sentences after mandibular advancement, whereas changes in nasalance were not significant for the sentences containing no nasal consonants after mandibular advancement. Mandibular advancement by a 13 mm using an EMA appliance did not significantly affect VPC. Instead, large variability among subjects in response to mandibular advancement. For 7 of the 14 subjects, the extent of VPC decreased significantly (p < .05) under the advanced mandible condition compared to the normal condition (without the EMA appliance). On the other hand, 5 subjects showed significantly (p < .05) increased VPC when their mandibles were advanced. For 2 subjects, VPC was not significantly changed with the advanced mandible. Conclusions: The outcomes of this study suggested that there was no statistical evidence to support that nasality was deteriorated by a 13mm mandibular advancement, which agreed with recent studies describing velopharyngeal function and nasality after orthognathic surgeries. VPC was not affected by mandibular advancement. Responses of the nasalance and VPC to mandibular advancement were dependent on the individuals. Further investigation such as electromyography method is needed to understand how velopharyngeal function and speech respond to mandibular advancement more definitely.

Obstructive sleep apnoea (OSA) is a common disorder characterized by repetitive closure of the upper airway during sleep and associated with significant adverse health effects including hypertension, heart disease and stroke. Current treatment with continuous positive airway pressure (CPAP) is highly effective but reduced compliance levels have resulted in suboptimal outcomes. Oral appliances such as mandibular advancement splints (MAS) are an alternative treatment and have potential advantages including greater patient compliance, comfort and portability. Although they have been shown to be successful across all categories of OSA severity, overall they are less effective than CPAP. A key limitation to its more widespread use has been the inability to predict which patients will be a treatment success. Prediction of treatment outcome would greatly enhance both MAS utilization and overall OSA management. However, little is known about the mechanisms of action of MAS therapy and a more detailed understanding is likely to improve patient selection and outcome. The aim of this thesis is to improve the prediction of treatment outcome through improved understanding of the mechanisms and site(s) of action of MAS therapy during sleep, through extrapolating this knowledge into daytime prediction tests and by developing prediction equations which can be tested prospectively. The work in this thesis presents novel ideas and findings. It is the first to examine and find that MAS therapy improves upper airway collapsibility during sleep. The site(s) of upper airway collapse was also examined and found to predict treatment outcome. Primary oropharyngeal collapse during sleep predicted treatment success and this was extrapolated into a simple daytime test hypothesized to reflect oropharyngeal function. These primary oropharyngeal collapsers were found to have characteristic awake flow-volume curves and this was then studied prospectively. Cephalometric X-rays and anthropomorphic measurements were also evaluated to formulate prediction equations for treatment outcome with MAS. These new findings together with their implications for clinical practice and future research are then summarized. It is concluded, however, that although many advancements have been made, the mechanisms of MAS action and prediction of treatment outcome remain incompletely understood reflecting the complex pathophysiology of the upper airway.

Made available in DSpace on 2014-06-11T19:31:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-07-13Bitstream added on 2014-06-13T20:01:38Z : No. of bitstreams: 1 ernica_nm_dr_araca.pdf: 1284533 bytes, checksum: 9186b8eff23dab32f9ca59df2b2a5921 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O objetivo deste estudo foi avaliar subjetivamente a imagem de perfil de tecido mole predictiva gerada por computador, em pacientes submetidos à cirurgia ortognática de avanço mandibular isolado, e, conseqüentemente, se o uso dela é aceitável para comunicação e elucidação do paciente durante o plano de tratamento, comparando os programas Dolphin Imaging e Dentofacial Planner Plus. Doze pacientes portadores de deficiência mandibular horizontal foram fotografados de perfil no préoperatório e 5 meses depois da cirurgia, no mínimo, sendo as imagens pós-operatórias confrontadas com as imagens predictivas produzidas pelos programas de imagem. Essas imagens foram analisadas por 100 cirurgiões-dentistas (50 cirurgiões buco-maxilo-faciais e 50 ortodontistas) que preencheram uma tabela de análise para cada imagem avaliada. Os resultados mostraram que: 1) O programa Dolphin Imaging foi o mais citado nos escores excelente e muito bom em todos os pontos de análise (ponta nasal, ângulo nasolabial, lábio superior, lábio inferior, região mentoniana, base mandibular, sulco lábio-mentoniano e geral), enquanto o programa Dentofacial Planner Plus foi o mais citado nos escores regular e ruim; 2) No escore bom houve um empate entre os dois programas nos pontos lábio superior e lábio inferior , sendo o programa Dentofacial Planner Plus preferido para o ponto base mandibular e o programa Dolphin Imaging para os demais pontos de análise (ponta nasal, ângulo nasolabial, região mentoniana, sulco lábio-mentoniano e geral); e 3) Existe uma predominância média de escores muito bom e bom para o programa Dolphin Imaging e de escores bom e regular para o programa Dentofacial Planner Plus. Deste modo, nas imagens de avanço mandibular, diante da metodologia empregada e dos dados obtidos no presente estudo,... / The aim of this study was to evaluate subjectively computer-generated soft tissue profile prediction in patients who underwent orthognathic surgery for mandibular advancement only and, consequently, if its usage is acceptable as a patient communication and education tool during the treatment plan. Two softwares were compared: Dolphin Imaging and Dentofacial Planner Plus. Pictures were taken from twelve patients with mandibular hypoplasia in the preoperative and at least 5 months postoperative period. The postoperative images were compared with the prediction generated by the two softwares. These images were evaluated by 100 dentists (50 oralmaxillofacial surgeons and 50 orthodontists) who filled in one correspondent table to each analyzed image. The results showed that: 1) Dolphin Imaging software was mentioned more times as excellent and very good in every analysis point (tip of the nose, nasolabial angle, upper lip, lower lip, chin, mandibular base, labiomental fold, and general), while Dentofacial Planner Plus software was scored fair and poor more frequently. 2) For the score good, there was a tie between the two softwares at the points upper lip and lower lip, and the software Dentofacial Planner Plus was preferred to the mandibular base point, while Dolphin Imaging was to all the other points left (tip of the nose, nasolabial angle, chin, labiomental fold, and general); and, 3) The majority of the mean scores were very good and good to Dolphin Imaging and good and fair to Dentofacial Planner Plus. Thus, according to the methodology and data obtained it is possible to conclude that to mandibular advancement images: the data show that both softwares are well accepted to soft tissue profile prediction, which suggests that both of them can be used as a communication tool with the patient during the treatment plan. However, Dolphin Imaging showed better results in this present study.

Resumo: O objetivo deste estudo foi avaliar subjetivamente a imagem de perfil de tecido mole predictiva gerada por computador, em pacientes submetidos à cirurgia ortognática de avanço mandibular isolado, e, conseqüentemente, se o uso dela é aceitável para comunicação e elucidação do paciente durante o plano de tratamento, comparando os programas Dolphin Imaging e Dentofacial Planner Plus. Doze pacientes portadores de deficiência mandibular horizontal foram fotografados de perfil no préoperatório e 5 meses depois da cirurgia, no mínimo, sendo as imagens pós-operatórias confrontadas com as imagens predictivas produzidas pelos programas de imagem. Essas imagens foram analisadas por 100 cirurgiões-dentistas (50 cirurgiões buco-maxilo-faciais e 50 ortodontistas) que preencheram uma tabela de análise para cada imagem avaliada. Os resultados mostraram que: 1) O programa Dolphin Imaging foi o mais citado nos escores "excelente" e "muito bom" em todos os pontos de análise (ponta nasal, ângulo nasolabial, lábio superior, lábio inferior, região mentoniana, base mandibular, sulco lábio-mentoniano e geral), enquanto o programa Dentofacial Planner Plus foi o mais citado nos escores "regular" e "ruim"; 2) No escore "bom" houve um empate entre os dois programas nos pontos ‘lábio superior’ e ‘lábio inferior’, sendo o programa Dentofacial Planner Plus preferido para o ponto ‘base mandibular’ e o programa Dolphin Imaging para os demais pontos de análise (ponta nasal, ângulo nasolabial, região mentoniana, sulco lábio-mentoniano e geral); e 3) Existe uma predominância média de escores "muito bom e "bom" para o programa Dolphin Imaging e de escores "bom" e "regular" para o programa Dentofacial Planner Plus. Deste modo, nas imagens de avanço mandibular, diante da metodologia empregada e dos dados obtidos no presente estudo,...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of this study was to evaluate subjectively computer-generated soft tissue profile prediction in patients who underwent orthognathic surgery for mandibular advancement only and, consequently, if its usage is acceptable as a patient communication and education tool during the treatment plan. Two softwares were compared: Dolphin Imaging and Dentofacial Planner Plus. Pictures were taken from twelve patients with mandibular hypoplasia in the preoperative and at least 5 months postoperative period. The postoperative images were compared with the prediction generated by the two softwares. These images were evaluated by 100 dentists (50 oralmaxillofacial surgeons and 50 orthodontists) who filled in one correspondent table to each analyzed image. The results showed that: 1) Dolphin Imaging software was mentioned more times as excellent and very good in every analysis point (tip of the nose, nasolabial angle, upper lip, lower lip, chin, mandibular base, labiomental fold, and general), while Dentofacial Planner Plus software was scored fair and poor more frequently. 2) For the score "good", there was a tie between the two softwares at the points upper lip and lower lip, and the software Dentofacial Planner Plus was preferred to the mandibular base point, while Dolphin Imaging was to all the other points left (tip of the nose, nasolabial angle, chin, labiomental fold, and general); and, 3) The majority of the mean scores were very good and good to Dolphin Imaging and good and fair to Dentofacial Planner Plus. Thus, according to the methodology and data obtained it is possible to conclude that to mandibular advancement images: the data show that both softwares are well accepted to soft tissue profile prediction, which suggests that both of them can be used as a communication tool with the patient during the treatment plan. However, Dolphin Imaging showed better results in this present study. / Orientador: Idelmo Rangel Garcia Júnior / Coorientador: Pedro Felipe Franco / Banca: Fábio Yoshio Tanaka / Banca: Laura Guimarães Pagliuso Paleckis / Banca: Osmar Aparecido Cuoghi / Banca: Eduardo Hochuli Vieira / Doutor