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.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2018-03-26T17:47:46Z No. of bitstreams: 1 danielamaralalvesmarliere.pdf: 4530634 bytes, checksum: 35c631563d509dbd177ef9d06c96497b (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-04-09T19:15:15Z (GMT) No. of bitstreams: 1 danielamaralalvesmarliere.pdf: 4530634 bytes, checksum: 35c631563d509dbd177ef9d06c96497b (MD5) / Made available in DSpace on 2018-04-09T19:15:15Z (GMT). No. of bitstreams: 1 danielamaralalvesmarliere.pdf: 4530634 bytes, checksum: 35c631563d509dbd177ef9d06c96497b (MD5) Previous issue date: 2018-01-12 / Objetivo: este estudo retrospectivo avaliou a acurácia entre os resultados obtidos e o planejamento assistido por computador (PAC) em cirurgia ortognática por meio do uso de modelos de superfície tridimensionais (3D) para aplicação em algoritmo de proximidade iterativa de pontos (PIP) e produção de mapas de cores por meio de programa computacional de engenharia reversa. Material e Métodos: a partir de arquivos de tomografia computadorizada cone-beam (TCFC) de 25 pacientes submetidos à cirurgia ortognática bimaxilar, foram gerados modelos 3D do PAC e pós-operatório em formato de arquivos STL (M0 e M1, respectivamente). Os M0 e M1 foram importados para programa computacional Geomagic Wrap, sendo aplicada a função de registro por meio do algoritmo PIP para alinhamento automático e cálculos dos desvios médios (MD, MD +, MD -, SD) e quadrado médio da raiz (RMS). Os mapas de cores foram gerados para avaliar a congruência qualitativa entre M0 e M1. A partir da análise dos desvios, os RMS(s) foram definidos como ‘3D Error’ que foi utilizado como indicador de mensuração de acurácia. As características da amostra foram apresentadas por análises de estatística descritiva. Para avaliar a reprodutibilidade do método, o fluxo de trabalho foi realizado por dois avaliadores independentes. Os testes t foram utilizados para avaliar as médias de MD, MD +, MD-, SD e ‘3D Error’, segundo a hipótese de todos os valores fossem menores ou igual a - 2 mm e maiores ou igual a 2 mm. Resultados: foram encontradas altas correlações intra e inter-avaliadores, favorecendo a reprodutibilidade do fluxo de trabalho no Geomagic Wrap. Testes t rejeitaram a hipótese de que os valores MDs e ‘3D Error’ eram menores que - 2 mm e maiores que 2 mm. Conclusão: este estudo apresentou a média de ‘3D Error’ (1,27 mm) estava dentro dos padrões de sucesso clínico inferior a 2 mm. O algoritmo PIP no Geomagic Wrap forneceu um método reprodutível para relacionar as malhas de superfície dos modelos 3D, e mapas de cores foram gerados para avaliar a congruência 3D. No entanto, não há respostas para todos os parâmetros metodológicos em relação à avaliação da acurácia em cirurgia ortognática. / Purpose: The aim of this retrospective study was to evaluate the accuracy between actual outcomes and virtual surgical planning (VSP) in orthognathic surgery regarding the use of three-dimensional (3D) surface models for registration using ICP algorithm and color maps by reverse engineering software. Materials and Methods: Construction of planning and postoperative 3D models in STL files format (M0 and M1, respectively) from CBCTs of 25 subjects who had been submitted to bimaxillary orthognathic surgery was performed. The M0 and M1 were sent to Geomagic Wrap Software in automatic alignment surface meshes order of M0 and M1 for registration using the ICP algorithm to calculate mean deviation (MD, MD+, MD-, SD) and root mean square (RMS). Color maps were generated to assess qualitative congruence between M0 and M1. From deviation analysis, the RMS(s) were defined as 3D Error which behaved as a measurement indicator of accuracy. The sample characteristics were shown by descriptive statistics. To evaluate the reproducibility of this method, the workflow was performed by two independent evaluators multiple times. t tests were used to assess whether all means of MD, MD+, MD-, SD and 3D Error values would be lower than - 2 mm and greater than 2 mm. Results: high intra and inter evaluators correlation were found, supporting the reproducibility of the workflow in Geomagic Wrap software. t tests proved that all MD(s) and 3D Error values were greater than - 2 mm and lower than 2 mm. Conclusion: This study showed 3D error mean (1,27 mm) within the standards of clinical success lower than 2 mm. ICP algorithm in Geomagic Wrap software provided a reproducible method of alignment between 3D models (surface meshes) and generated color maps to evaluate 3D congruence, but did not answer all methodological parameters regarding the assessment of accuracy in orthognathic surgery.

Notre pratique courante de la chirurgie orthognathique se heurte aux limites des outils standard de planification et de simulation ainsi qu’à l’absence d’assistance peropératoire. L’objectif de notre travail était de développer de nouveaux outils répondant à cette problématique. Ainsi, dans un premier temps, un algorithme de segmentation semi-automatique a permis une modélisation 3D patient-spécifique rapide et précise. Nous avons ensuite élaboré un logiciel de simulation des parties molles fondé sur un modèle mécanique de type masse-ressort permettant une précision millimétrique. Enfin, nous avons conçu un système de navigation temps-réel fondé sur un guidage électromagnétique mini-invasif doté d’une interface utilisateur intuitive. Son évaluation a montré une réduction de la variabilité inter-opérateurs. En plus de son caractère pédagogique, ce système bénéficiait particulièrement aux débutants. Les chirurgiens ont souligné l’intérêt de ce système, tant pour les dysmorphoses complexes que pour les cas de routine. Ces développements constituent ainsi une suite logicielle susceptible d’améliorer la qualité de prise en charge des patients. / In our routine practice of orthognathic surgery, we face the limitations of conventional planning and simulation tools, and the lack of convenient intraoperative assistance. If computer science has provided satisfactory solutions for planning, yet simulation and navigation appear improvable. The aim of our research was to provide novel tools to improve these issues. Therefore, we first developed a semi-automated segmentation pipeline allowing accurate and timeefficient patient-specific 3D modeling. We then conceived 1mm-accurate facial soft tissue simulation software based on a mechanical massspring model. Finally, we developed a real-time navigation system based on minimally-invasive electromagnetic tracking, featuring a novel user-friendly interface. Evaluation showed that our software reduced time and accuracy discrepancy between operators. Along with educational purposes, such a system benefited especially trainees. Surgeons emphasized system relevance in the treatment of both, complex and common deformities. Such developments establish a software suite that could provide significant improvement for patient optimal care.

Abstract Malocclusions and dentofacial deformities associate with physical, psychological and social functioning, which are included in the concept of oral health-related quality of life (OHRQoL). It is not clear, however, how different aspects related to malocclusion are associated with OHRQoL and how the possible associations interrelate during treatment. The aim of this study was to investigate the effect of treatment of severe malocclusion and related functional and esthetic changes on OHRQoL in adult patients who undergo orthodontic or orthodontic-surgical treatment. The study group comprised ninety-four adults (34 men and 60 women, age range 18–64 years) with severe malocclusion and considerable functional problem who were referred for orthodontic or orthodontic-surgical treatment in the Oral and Maxillofacial Department at Oulu University Hospital. Data were collected using questionnaires, dental casts, dental photographs and clinical examinations before and after treatment. OHRQoL (OHIP-14), facial pain and satisfaction with dental esthetics were measured with questionnaires. The methods to measure malocclusion, temporomandibular disorders (TMD) and dental esthetics were the Peer Assessment Rating (PAR) index, the Helkimo index and the Aesthetic Component (AC) of the IOTN. Before treatment, associations between severity of malocclusion, TMD, facial pain and OHRQoL differed between genders. OHRQoL, malocclusion, signs and symptoms of TMD, facial pain and satisfaction with dental esthetics improved significantly during the follow-up. The greatest improvement was seen in the OHRQoL dimensions psychological discomfort, physical pain and psychological disability. Improvement in satisfaction with dental esthetics and decreased facial pain associated with improved OHRQoL. In conclusion, treatment of severe malocclusion considerably improves OHRQoL. Especially satisfaction with dental esthetics and facial pain seem to be aspects that contribute to patients’ OHRQoL. Thus, the importance of dental esthetics and facial pain for patients should not be underestimated when making treatment decisions and assessing outcome. / Tiivistelmä Purentavirheet sekä hampaiston ja kasvojen poikkeavuudet ovat yhteydessä fyysiseen, psyykkiseen ja sosiaaliseen toimintaan. Suunterveyteen liittyvä elämänlaatu on käsite, joka sisältää nämä fyysiset, psyykkiset ja sosiaaliset osa-alueet. On kuitenkin epäselvää, miten purentavirheeseen liittyvät eri näkökohdat ja niiden muutokset ovat yhteydessä suunterveyteen liittyvään elämänlaatuun ja sen muutoksiin hoidon aikana. Tutkimuksen tavoitteena oli tutkia vaikean purentavirheen hoidon ja siihen liittyvien toiminnallisten ja esteettisten muutosten vaikutusta elämänlaatuun aikuispotilailla, joille tehtiin oikomishoito tai oikomishoito yhdistettynä leukakirurgiseen hoitoon. Tutkimusryhmän muodostivat 94 aikuista (34 miestä ja 60 naista, ikäjakauma 18–64 vuotta), joilla oli vaikea purentavirhe ja siihen liittyvä huomattava toiminnallinen haitta, ja jotka oli lähetetty ortodontiseen tai ortodontis-kirurgiseen hoitoon Oulun yliopistollisen sairaalan hammas- ja suusairauksien klinikalle. Tiedot kerättiin kyselylomakkeiden, kipsimallien, suuvalokuvien ja kliinisten tutkimusten avulla ennen hoitoa ja sen jälkeen. Suunterveyteen liittyvää elämänlaatua (OHIP-14), kasvokipua ja hampaiden ulkonäköön liittyvää tyytyväisyyttä mitattiin kyselykaavakkeella. Purentavirheen, purentaelimistön toimintahäiriöiden ja hampaiden ulkonäön mittaamiseen käytettiin PAR-indeksiä, Helkimo-indeksiä ja IOTN:n ulkonäköosiota. Purentavirheen vaikeusasteen, purentaelimistön toimintahäiriöiden, kasvokivun ja suunterveyteen liittyvän elämänlaadun väliset yhteydet erosivat ennen hoitoa naisten ja miesten välillä. Suunterveyteen liittyvä elämänlaatu, purenta, purentaelimistön toimintahäiriöt, kasvokipu ja tyytyväisyys hampaiden ulkonäköön paranivat seuranta-aikana. Suurin paraneminen havaittiin elämänlaadun osa-alueissa psyykkinen epämukavuus, kipu ja psyykkinen haitta. Hampaiden ulkonäön paraneminen ja kasvokivun väheneminen olivat yhteydessä suunterveyteen liittyvän elämänlaadun paranemiseen. Vaikean purentavirheen hoito paransi merkitsevästi suunterveyteen liittyvää elämänlaatua. Mitatuista muuttujista etenkin tyytyväisyys hampaiden ulkonäköön ja kasvokipu näyttävät olevan merkittäviä potilaan suunterveyteen liittyvän elämänlaadun kannalta. Tästä syystä hampaiden ulkonäön ja kasvokivun merkitystä potilaille ei tulisi aliarvioida hoitopäätöstä tehtäessä ja hoitotulosta arvioitaessa.

Le but de ce travail était la mise en place d’une chaîne méthodologique de planification virtuelle d’une ostéotomie sagittale des branches mandibulaires (OSBM) et son transfert au bloc opératoire. Dans la première partie, les méthodes classiques de planification et de transfert sont exposées. Habituellement réalisées à partir de modèles en plâtre sur articulateur, la planification et la production de guides occlusaux chirurgicaux souffrent d’une imprécision potentiellement à l’origine de troubles fonctionnels temporo-­‐mandibulaires. Le contrôle per-­‐opératoire du condyle mandibulaire lors de l’OSBM est un élément de stabilité squelettique dont dépend la qualité du résultat fonctionnel. Une évaluation des pratiques professionnelles des chirurgiens maxillo-­‐faciaux a été réalisée sur ce point. Une méthode de positionnement condylien utilisant un dispositif, moins fréquemment utilisée que la méthode empirique, est proposée comme présentant le meilleur rapport bénéfice/risque. Cette méthode a été reproduite virtuellement à travers les différents maillons de la chaîne méthodologique. Des techniques innovantes informatisées d’acquisition, de conception et modélisation, et d’impression en 3 dimensions ont été utilisées. Dans la seconde partie, la méthodologie de chacun des maillons de la chaîne a été présentée et évaluée, soit sur sujets cadavériques, soit sur patients. L’objectif était de démontrer la faisabilité de la chaîne. Le maillon « acquisition et extraction de surface » a mis en exergue le problème des artéfacts dus aux matériaux métalliques dentaires ou orthodontiques. Dans 90% des cas le maillage obtenu était satisfaisant, permettant de s’affranchir des modèles en plâtre. Le maillon « planification chirurgicale virtuelle » a montré une valorisation par rapport à la technique classique en terme de prévention des interférences des pièces osseuses déplacées. Le maillon « modélisation et impression du guide chirurgical » a décrit les étapes d’invention d’un guide de positionnement occlusal et condylien (OCPD : occlusal and condylar positionning device). Ses caractéristiques techniques, ses modalités de production par impression 3D ainsi que son utilisation peropératoire, ont été précisées. Enfin le maillon « évaluation de l’OCPD » a permis de montrer la faisabilité de la méthode et l’équivalence clinique, technique et biologique de ce dispositif médical sur mesure par rapport à ceux utilisés dans la méthode classique. Enfin le positionnement condylien obtenu grâce à ce dispositif a été évalué de manière préliminaire et comparé aux données de la littérature. Grâce à l’OCPD, nous avons montré la possibilité de transférer au bloc opératoire la planification virtuelle d’une OSBM contrôlant la position des condyles / The purpose of this work was the implementation of a methodological chain for bilateral sagittal split osteotomy (BSSO) virtual planning and its transfer in the operating room. In the first part of the work, usual methods for planning BSSO are exposed. Usually realized from plaster models on articulator, the planning and the occlusal surgical guides production are at risk of temporo-­‐mandibular functional disorders. The quality of the functional result depends on the correct positioning of the mandibular condyle, considered as a skeletal stability element. An assessment of the maxillofacial surgeons practices was realized regarding intra-­‐operative condyle positioning. Using a condylar positioning device (CPD),less frequently employed than the empirical method, meets an acceptable benefit/risk balance. This method was virtually reproduced through various steps of the methodological chain described. Computerized innovative techniques for three-­‐dimensional acquisition, design and manufacturing were used. In the second part of the work, the methodology of each step of the chain was presented and estimated, either on cadaveric subjects, or on patients. The aim was to demonstrate the feasibility of the whole chain. The “acquisition and surface extraction” step pointed the issue of artefacts due to dental or orthodontic metallic devices. Ninety % of the obtained meshes were satisfactory, allowing not to use plaster models. The “virtual surgical planning” step allowed reproducing the usual method and showed great interest in bone interferences prevention. The “modelling and printing of the surgical guide” step described the stages of occlusal and condylar positioning device (OCPD) invention. Its technical characteristics, its methods of manufacturing by 3D printing, and its intraoperative use were specified. The step “OCPD evaluation” showed the method feasibility and the clinical, technical and biological equivalence of this custom-­‐made medical device as compared to those used in the usual method. Finally the condylar position obtained with this device was estimated in a preliminary clinical study and compared with the literature. Thanks to the OCPD, we showed the possibility of transferring in the operating room an OSBM virtual planning controlling condyles position.

O objetivo deste estudo foi comparar o eixo de rotação verdadeiro com o anatômico em ambiente virtual 3D, e seus efeitos sobre dois pontos anatômicos mandibulares. O eixo verdadeiro foi determinado em 14 indivíduos por meio de axiografia, e transferido para o ambiente virtual por TCFC, e posteriormente determinado anatomicamente, onde foram medidas as distâncias entre ambos. Foram simuladas rotações de 2º, 5º e 8º da mandíbula nos dois eixos, tanto para abertura como fechamento, e quantificadas as diferenças nos pontos da linha média inferior (LMI) e pogônio (Pg). O teste t pareado foi utilizado para examinar as diferenças entre as médias nas posições desses pontos (p<0,05). Os eixos verdadeiros localizaram-se dentro de um raio de 5 mm do anatômico em 67,86% da amostra. A distância absoluta média entre os eixos foi de 4,79 mm, enquanto que a vetorial foi de 2,33 no plano horizontal e 3,03 mm no vertical, resultando na direção anteroinferior em 71,43% dos eixos verdadeiros. Houve diferença estatisticamente significante na posição dos pontos LMI e Pg para todas as magnitudes e direções, entre os eixos. O eixo verdadeiro está localizado na direção anteroinferior em relação ao anatômico. Os efeitos na mandíbula são significantes e diferentes em todas as amplitudes, tanto para abertura como fechamento, porém com possível pequena relevância clínica. / The aim of this study was to compare the true hinge axis to the anatomic one in a virtual 3D environment, and also their respective effects on two mandibular anatomic points. The true axis has been determined in 14 individuals by means of axiography, and later transferred to a virtual environment by CBTC, where the anatomical axis was determined, and measured the distances between them. Mandibular rotation of 2º, 5º and 8º in both axes were performed, both for opening and closing, as well as the quantification of the difference found in the points of the lower midline (LM) and pogonion (Pg). Paired t-test was used to examine differences between the average values in the position of those points (p<0,05). The true axis was located within a 5mm-radius of the anatomic axis throughout 67.86% of the sample. The average absolute distance between the axes was 4.79 mm, while the vector distance was 2.33 mm in the horizontal plane e 3.03mm in the vertical plane, amounting to an anteriorinferior direction of 71.43% of the true axis. There was significant difference in the position of points LM and Pg to all magnitudes and directions within the axes. The true hinge axis is located in the anterior-inferior direction in relation to the anatomic axis. The effects observed onto the mandible are significant and different in all amplitudes, both for opening and closing positions, however they present small clinical relevance.

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

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

O objetivo deste estudo foi comparar o eixo de rotação verdadeiro com o anatômico em ambiente virtual 3D, e seus efeitos sobre dois pontos anatômicos mandibulares. O eixo verdadeiro foi determinado em 14 indivíduos por meio de axiografia, e transferido para o ambiente virtual por TCFC, e posteriormente determinado anatomicamente, onde foram medidas as distâncias entre ambos. Foram simuladas rotações de 2º, 5º e 8º da mandíbula nos dois eixos, tanto para abertura como fechamento, e quantificadas as diferenças nos pontos da linha média inferior (LMI) e pogônio (Pg). O teste t pareado foi utilizado para examinar as diferenças entre as médias nas posições desses pontos (p<0,05). Os eixos verdadeiros localizaram-se dentro de um raio de 5 mm do anatômico em 67,86% da amostra. A distância absoluta média entre os eixos foi de 4,79 mm, enquanto que a vetorial foi de 2,33 no plano horizontal e 3,03 mm no vertical, resultando na direção anteroinferior em 71,43% dos eixos verdadeiros. Houve diferença estatisticamente significante na posição dos pontos LMI e Pg para todas as magnitudes e direções, entre os eixos. O eixo verdadeiro está localizado na direção anteroinferior em relação ao anatômico. Os efeitos na mandíbula são significantes e diferentes em todas as amplitudes, tanto para abertura como fechamento, porém com possível pequena relevância clínica. / The aim of this study was to compare the true hinge axis to the anatomic one in a virtual 3D environment, and also their respective effects on two mandibular anatomic points. The true axis has been determined in 14 individuals by means of axiography, and later transferred to a virtual environment by CBTC, where the anatomical axis was determined, and measured the distances between them. Mandibular rotation of 2º, 5º and 8º in both axes were performed, both for opening and closing, as well as the quantification of the difference found in the points of the lower midline (LM) and pogonion (Pg). Paired t-test was used to examine differences between the average values in the position of those points (p<0,05). The true axis was located within a 5mm-radius of the anatomic axis throughout 67.86% of the sample. The average absolute distance between the axes was 4.79 mm, while the vector distance was 2.33 mm in the horizontal plane e 3.03mm in the vertical plane, amounting to an anteriorinferior direction of 71.43% of the true axis. There was significant difference in the position of points LM and Pg to all magnitudes and directions within the axes. The true hinge axis is located in the anterior-inferior direction in relation to the anatomic axis. The effects observed onto the mandible are significant and different in all amplitudes, both for opening and closing positions, however they present small clinical relevance.

Historique & Objectifs: Les effets de l’avancement maxillaire (AM) sur l’anatomie velopharyngée ont déjà été étudiés en utilisant la céphalométrie. Cette modalité ne permet toutefois pas de bien caractériser les tissus mous. Le but de cette étude est de comparer la configuration de l’espace vélopharyngé en pré- et post-opératoire, telle que mesurée par tomodensitométrie (TDM). De plus, notre objectif est d’analyser et de comparer les différences dans ces mesures chez les patients avec et sans fente palatine (FP). Méthodologie: Ceci est une étude rétrospective portant sur 44 patients avec et sans FP, traités avec AM pour une hypoplasie maxillaire et une malocclusion dento-squelettique. Les TDM pré- et post-opératoires ont été comparés en se basant sur des repères préétablis. Des distances linéaires, des aires de sections transversales et des mesures volumétriques ont été mesurées en utilisant des reconstructions tridimensionnelles des TDM. Résultats: Pour les distances linéaires mesurées, une différence statistiquement significative a été notée pour les mesures linéaires du nasopharynx et du palais mou (25.1 vs 28.5 mm p=0.001 et 6.5 vs 7.6 mm p=0.026, respectivement). Les aires des sections transversales au niveau du nasopharynx et du palais mou ainsi que l'évaluation volumétrique de l'espace vélopharyngé n'ont pas démontrées une différence statistiquement significative en comparant les mesures en pré- et post-opératoire (p>0,05). En comparant les patients avec et sans FP, une différence statistiquement significative n’a été notée que pour la distance linéaire et l’aire de la section transversale du nasopharynx (p=0.045 et p=0.04, respectivement). Un antécédent de réparation de FP n’était pas prédictif de différences de mesures pré- et post-opératoire. Conclusion: Nos résultats confirment que, bien que certaines modifications structurelles de l’espace vélopharyngé soient inhérentes à l’AM chez les patients avec FP, leurs aires et volumes ne semblent pas changer de façon significative. Ces changements sont indépendants d’une histoire de FP réparée. / Background & Purpose: The effects of maxillary advancement (MA) on velopharyngeal anatomy have primarily been studied using lateral cephalometric radiographs. However, with recent advances in orthognathic surgery, there is an increased need for more detailed and precise imaging such as computerized tomographic (CT) scan reconstructions, to help in surgical planning and to measure outcomes. The purpose of this study is to compare the pre-and post-operative velopharyngeal space configuration modifications as measured on CT scans. The aim is also to assess differences in these airway measures between patients with and without history of prior repaired cleft palate (CP). Methods: This is a retrospective cohort study of 44 patients with and without CP who were treated with MA for midface hypoplasia and secondary malocclusion at skeletal maturity. The pre-and post-operative CT scans were compared with respect to pre-established landmarks. Linear distances, cross-sectional areas, and volumes were measured using 3-dimensional (3D) CT scan reconstructions. Results: For the linear distances measured, a statistically significant difference was found when comparing the pre-and post-operative measures of the narrowest part of the nasopharynx and the narrowest part of the retropalatal airway space (25.1 vs 28.5 mm p=0.001 and 6.5 vs 7.6 mm p=0.026, respectively). Retropalatal cross-sectional areas, nasopharyngeal cross-sectional areas and the volumetric assessment of the nasopharyngeal space showed no statistically significant differences when comparing pre-and post-operative scans (p>0.05). The main effect of palatal repair (CP vs. Non-CP) showed that there was only a statistically significant difference for the measures of the narrowest part of the nasopharynx and the nasopharyngeal cross-sectional area (p=0.045 and p=0.04, respectively). Mean changes in the measures did not differ over time (pre-and post-op) depending on whether there was prior history of CP repair. Conclusion: Our results support the hypothesis that although structural modifications of the pharyngeal space are inherent to MA in patients with CP, its surface area and volume do not change significantly. These changes are also independent of history of previous CP repair.