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Background The use of three-dimensional (3D) surface imaging is becoming more popular and accepted in the fields of Medicine and Dentistry. The present study aims to develop a technique to automatically localise and quantify soft-tissue asymmetry in adults using 3D facial scans. This may be applied as a diagnostic tool to monitor growth and dynamic changes and to evaluate treatment outcomes. Methods 3D facial surface data were captured from 55 adults comprising 28 symmetrical faces and 27 asymmetrical faces using a 3dMDface system. A landmark-independent method, which compared the original and the mirrored 3D facial data, was developed to quantify the asymmetry. A Weibull distribution-based probabilistic model was generated from the root-mean-square (RMS) error data for the symmetrical group to designate a level of asymmetry which represented a normal range. Results Statistically significant (p

Malokluzije II klase predstavljaju najčešću nepravilnost u ortodontskim klinikama širom sveta, dostiţući udeo od 55% svih malokluzija, po najnovijim podacima. Ova vrsta nepravilnosti narušava facijalnu harmoniju i menja izgled pacijenta na gore. U okviru malokluzija II klase, najčešće je prisutna nepravilnost 1. odeljenja, sa protrudiranim gornjim frontalnim zubima. Malokluzije II klase, 1. odeljenja utiču na promenu izgleda nosa, usana, brade, tačnije celog donjeg sprata lica. Narušavanjem izgleda donjeg sprata lica, dolazi do velike diskrepance i u odnosu ovog dela lica sa srednjim i gornjim spratom lica, što indirektno utiče na izgled celog lica, i to delova koji su udaljeni od ortodontskog problema, tj. postojeće malokluzije. Profil je naročito ugroţen, u smislu povećanja konveksiteta, uvučenosti brade, sa neestetski isturenom gornjom usnom, lošim poloţajem i uvučenom donjom usnom i naglašenim bradnim sulkusom. Veliki incizalni stepenik pogoršava izgled profila i narušava samopouzdanje pacijenta. Naime, iako ortodontska terapija deluje u sve tri ravni prostora, izgled profila pacijenata je ono što je najprimetnije promenjeno, i na šta se fokusira paţnja ortodonta tokom terapije, a posledično dovodi do, blage i diskutabilne promene izgleda anfasa na bolje. Postoji nekoliko načina za lečenje ove vrste malokluzije. Terapija se moţe podeliti na terapiju funkcionalnim aparatima - pokretnim ili fiksnim (u zavisnosti od uzrasta pacijenata u kom se započne terapija moţemo govoriti o modifikaciji i usmeravanju dentofacijalnog rasta), zatim fiksnim ortodontskim aparatima najčešće u kombinaciji sa ekstrakcijom zuba u gornjoj ili obe vilice (takozvana kamuflaţna terapija), i kombinovanom ortodontskom i hirurškom terapijom u najekstremnijim slučajevima. Naučni ciljevi ovog istraţivanja bili su: 1. Analizom profilnih telerendgenskih snimaka pre i posle terapije kod pacijenata sa malokluzijom II klase, utvrditi promene nastale lečenjem fiksnim funkcionalnim aparatom bez ekstrakcije i dobijene vrednosti uporediti sa promenama nastalim kod pacijenata lečenih terapijom kamuflaţe II klase sa ekstrakcijom premolara; 2. Antropometrijskim merenjem uglova i proporcija na fotografijama profila i anfasa obe grupe pacijenata: Ispitati kod kojih angularnih parametara mekotkivnog profila dolazi do najvećih promena i koliko se novonastale vrednosti parametara pribliţavaju idealnim vrednostima, koliko je odstupanje vrednosti parametara od idealnih proporcija, posebno u donjoj trećini lica, kao i ispitati razliku u antropometrijskim linearnim parametrima lica pre i nakon završene ortodontske terapije... Class II malocclusions are the most common irregularities in orthodontic clinics around the world, with 55 % share of all malocclusions, according to newest data. This type of irregularity deteriorates facial harmony and worsens the patient`s profile. Division 1, with protruded upper frontal teeth, is the most frequent type of this malocclusion. Class II malocclusions affect the look of nose, lips, chin and the entire lower facial third. Worsening of the lower facial third causes discrepancy of facial thirds relations, which indirectly affects the facial look in general, even entities which are away of present malocclusion. Profile is deeply affected, in the terms of bigger convexity, retruded chin, very often unaesthetically protruded upper lip, retruded lower lip and pronounced mentolabial sulcus. Big overjet worsens profile look and undermines patient`s self-esteem. Albeit orthodontic treatment improves sagittal, transversal and vertical dimension, profile look is mostly changed, and represents the clinician`s focus during treatment, and change in this feature consequently changes en-face look. There are several different treatments for this type of malocclusion. Treatment can be divided into functional appliance treatment - both removable and fixed (depending on the patient`s age when the treatment is started we can argue about growth modification), then fixed appliance treatment most commonly combined with upper or all four premolars extractions (so - called camouphlage treatment), and finally for extreme cases combined orthodontic and orthognathic surgical treatment. The aims of this study were: 1. To determine the changes caused by fixed functional appliance treatment (non-extraction) and camouphlage treatment (extraction) in Class II malocclusion patients, visible on lateral cephalograms; 2. To evaluate the changes in softtissue angular parameters, then how much the newly values approach the ideal standards, especially in lower facial third, and to examinate the difference in linear facial parameters before and after the orthodontic treatment, by measuring these linear and angular parameters on profile and en-face patient`s photos...

Class II malocclusions are the most common irregularities in orthodontic clinics around the world, with 55 % share of all malocclusions, according to newest data. This type of irregularity deteriorates facial harmony and worsens the patient`s profile. Division 1, with protruded upper frontal teeth, is the most frequent type of this malocclusion. Class II malocclusions affect the look of nose, lips, chin and the entire lower facial third. Worsening of the lower facial third causes discrepancy of facial thirds relations, which indirectly affects the facial look in general, even entities which are away of present malocclusion. Profile is deeply affected, in the terms of bigger convexity, retruded chin, very often unaesthetically protruded upper lip, retruded lower lip and pronounced mentolabial sulcus. Big overjet worsens profile look and undermines patient`s self-esteem. Albeit orthodontic treatment improves sagittal, transversal and vertical dimension, profile look is mostly changed, and represents the clinician`s focus during treatment, and change in this feature consequently changes en-face look. There are several different treatments for this type of malocclusion. Treatment can be divided into functional appliance treatment - both removable and fixed (depending on the patient`s age when the treatment is started we can argue about growth modification), then fixed appliance treatment most commonly combined with upper or all four premolars extractions (so - called camouphlage treatment), and finally for extreme cases combined orthodontic and orthognathic surgical treatment. The aims of this study were: 1. To determine the changes caused by fixed functional appliance treatment (non-extraction) and camouphlage treatment (extraction) in Class II malocclusion patients, visible on lateral cephalograms; 2. To evaluate the changes in softtissue angular parameters, then how much the newly values approach the ideal standards, especially in lower facial third, and to examinate the difference in linear facial parameters before and after the orthodontic treatment, by measuring these linear and angular parameters on profile and en-face patient`s photos..., Malokluzije II klase predstavljaju najčešću nepravilnost u ortodontskim klinikama širom sveta, dostiţući udeo od 55% svih malokluzija, po najnovijim podacima. Ova vrsta nepravilnosti narušava facijalnu harmoniju i menja izgled pacijenta na gore. U okviru malokluzija II klase, najčešće je prisutna nepravilnost 1. odeljenja, sa protrudiranim gornjim frontalnim zubima. Malokluzije II klase, 1. odeljenja utiču na promenu izgleda nosa, usana, brade, tačnije celog donjeg sprata lica. Narušavanjem izgleda donjeg sprata lica, dolazi do velike diskrepance i u odnosu ovog dela lica sa srednjim i gornjim spratom lica, što indirektno utiče na izgled celog lica, i to delova koji su udaljeni od ortodontskog problema, tj. postojeće malokluzije. Profil je naročito ugroţen, u smislu povećanja konveksiteta, uvučenosti brade, sa neestetski isturenom gornjom usnom, lošim poloţajem i uvučenom donjom usnom i naglašenim bradnim sulkusom. Veliki incizalni stepenik pogoršava izgled profila i narušava samopouzdanje pacijenta. Naime, iako ortodontska terapija deluje u sve tri ravni prostora, izgled profila pacijenata je ono što je najprimetnije promenjeno, i na šta se fokusira paţnja ortodonta tokom terapije, a posledično dovodi do, blage i diskutabilne promene izgleda anfasa na bolje. Postoji nekoliko načina za lečenje ove vrste malokluzije. Terapija se moţe podeliti na terapiju funkcionalnim aparatima - pokretnim ili fiksnim (u zavisnosti od uzrasta pacijenata u kom se započne terapija moţemo govoriti o modifikaciji i usmeravanju dentofacijalnog rasta), zatim fiksnim ortodontskim aparatima najčešće u kombinaciji sa ekstrakcijom zuba u gornjoj ili obe vilice (takozvana kamuflaţna terapija), i kombinovanom ortodontskom i hirurškom terapijom u najekstremnijim slučajevima. Naučni ciljevi ovog istraţivanja bili su: 1. Analizom profilnih telerendgenskih snimaka pre i posle terapije kod pacijenata sa malokluzijom II klase, utvrditi promene nastale lečenjem fiksnim funkcionalnim aparatom bez ekstrakcije i dobijene vrednosti uporediti sa promenama nastalim kod pacijenata lečenih terapijom kamuflaţe II klase sa ekstrakcijom premolara; 2. Antropometrijskim merenjem uglova i proporcija na fotografijama profila i anfasa obe grupe pacijenata: Ispitati kod kojih angularnih parametara mekotkivnog profila dolazi do najvećih promena i koliko se novonastale vrednosti parametara pribliţavaju idealnim vrednostima, koliko je odstupanje vrednosti parametara od idealnih proporcija, posebno u donjoj trećini lica, kao i ispitati razliku u antropometrijskim linearnim parametrima lica pre i nakon završene ortodontske terapije...

Submitted by Cristina Afonso (cac@lisboa.ucp.pt) on 2016-04-06T15:14:49Z No. of bitstreams: 1 Inês Martins - Dissertação de Mestrado.pdf: 409257943 bytes, checksum: d3bef7d95f0d61c0c72b304183b6cd65 (MD5) Approved for entry into archive by Cristina Afonso (cac@lisboa.ucp.pt) on 2016-04-06T15:15:14Z (GMT) No. of bitstreams: 1 Inês Martins - Dissertação de Mestrado.pdf: 409257943 bytes, checksum: d3bef7d95f0d61c0c72b304183b6cd65 (MD5) Made available in DSpace on 2016-04-06T15:15:14Z (GMT). No. of bitstreams: 1 Inês Martins - Dissertação de Mestrado.pdf: 409257943 bytes, checksum: d3bef7d95f0d61c0c72b304183b6cd65 (MD5) Previous issue date: 2015-09-07

Seria interessante que todas as especialidades odontológicas envolvidas com a Odontologia Estética utilizassem parâmetros estéticos dentários e faciais que fossem comuns a todos os profissionais. Considerando que essa tarefa só poderá ser exercida quando as especialidades puderem contar com análises estéticas simplificadas que sejam do entendimento de todos, esse trabalho propõe-se a apresentar os Diagramas de Referências Estéticas Dentárias e Faciais, que terão o intuito de prover uma avaliação da estética dentofacial, de uma forma simples, individualizada e subjetiva de cada paciente, e que servem como instrumentos de referência para todas as especialidades odontológicas, auxiliando no diagnóstico e planejamento dos tratamentos multidisciplinares.It would be interesting if all odontological specialties engaged in the Esthetic Dentistry could use dental and facial esthetics parameters common to all professionals. Considering that this task will only be performed when the specialties can count upon a simplified esthetic analysis that everybody understands, this study aim to show Dental and Facial Esthetic References Diagrams in order to help both the diagnosis and planning of multidisciplinary treatments.

The purpose of the present study was to assess and determine if the correlation between certain facial measurements was significant to recommend their use as reliable aesthetic factors for selection of suitable tooth moulds for anterior teeth restoration. The materials for this study included 50 cephalometric radiographs for selected undergraduate students of Dentistry Collage, Mosul University; 25 males and 25 females. The age ranged from 18–25 years old with normal occlusion. The data were analyzed by using Minitab system and the result confirmed that certain facial measurements considered directly to determine the outline form to restore anterior teeth such as tooth width at the incisor edge, incisor tooth length, intercanine distance, the ratio of incisor tooth length and tooth width at the incisor edge, bi–incisors width, and bi–orbital width, while the others, bi–zygomatic width, intermolar distance, anterior facial height, and the ratio of anterior facial height and bi–zygomatic width, were indirectly indicated. Also there was a significant difference between male and female groups with different facial measurements. The ratio of the anterior facial height to bi–zygomatic width for the total sample was 0.93 mm, while that for the tooth length to tooth width was 0.81 mm. It could be concluded that certain facial measurements recommended as reliable aesthetic factors for selection of suitable tooth moulds for anterior teeth restoration.

Este artigo compreende a segunda parte da análise facial frontal em fotografias padronizadas. Fizeram parte da amostra estudada 40 mulheres, com idade média de 22 anos, leucodermas, com faces agradáveis, Classe I de Angle, sem história prévia de tratamento ortodôntico e cirurgia plástica na face. Foram obtidas fotografias faciais frontais (10x15cm coloridas), padronizadas. Duas fotografias foram obtidas, no sorriso máximo e durante o repouso. Sobre as fotografias, foram realizadas medidas lineares, angulares e proporcionais. As medidas foram avaliadas por meio de teste de normalidade, estatística descritiva e desvio padrão do erro. Os resultados mostraram que algumas das medidas utilizadas neste trabalho se assemelham às encontradas na literatura e outras diferem muito. E a partir desse estudo propõem-se uma análise facial frontal para utilização rotineira no diagnóstico e planejamento do tratamento ortodôntico.This is the second part of the frontal facial analysis using standardized photographs. The sample consisted of 40 white female with a mean age of 22 years old, pleasant face, normal occlusion, and had not been previously submitted to orthodontic treatment nor plastic surgery. Colorful standardized 10x15 cm photographs were obtained with the patients in their natural head position. Two pictures were taken for each subject, one in maximum smile and another in rest position. Linear, angular and proportional measurements were used. Tests of normality, descriptive statistics, and error standard deviations were executed. The results showed that some of the measurements used in this study have values similar to that found in the literature and some are very different. All of the measurements were reliable after their repetition. And after this study, it is suggested a frontal facial analysis to be used regularly in the diagnosis and orthodontic treatment planning.

Considerando a importância da análise facial frontal no diagnóstico, esse trabalho propõem-se a apresentar uma análise facial frontal em fotografias padronizadas, em repouso e durante o sorriso, que possa auxiliar no diagnóstico e planejamento do tratamento ortodôntico e cirúrgico como também na avaliação dos resultados obtidos. Fizeram parte da amostra estudada 40 mulheres, com idade média de 22 anos, leucodermas, com faces agradáveis, Classe I de Angle, sem história prévia de tratamento ortodôntico e/ou cirurgia plástica na face. Foram obtidas fotografias faciais frontais (10x15cm coloridas), padronizadas. Em repouso e durante o sorriso máximo. Sobre as fotografias, foram realizadas medidas lineares, angulares e proporcionais. As medidas foram avaliadas por meio de teste de normalidade, estatística descritiva e desvio padrão do erro. Os resultados mostraram que algumas das medidas utilizadas em nosso trabalho se assemelham às encontradas na literatura e outras diferem muito. E a partir desse estudo propõe-se uma análise facial frontal para utilização no diagnóstico e planejamento do tratamento ortodôntico e cirúrgico.Considering the importance of the frontal facial analysis in the diagnosis, the purpose of this research is to present a frontal facial analysis using standardized photographs, in rest position and during the smile, as an aid in the diagnosis and planning of the orthodontic and surgical treatment as well as in the evaluation of treatment results. The sample consisted of 40 white female subjects with a mean age of 22 years old, pleasant face, normal occlusion, and had not been previously submitted to orthodontic treatment nor plastic surgery. Colorful standardized 10x15 cm photographs were obtained with the patients in their natural head position. Two pictures were taken for each subject, one in maximum smile and another in rest position. Linear, angular and proportional measurements were used. Tests of normality, descriptive statistics, and error standard deviation were executed. The results showed that some of the measurements used in this study have values similar to that found in the literature and some are very different. All of the measurements were reliable after their repetition. And after this study, it is suggested a frontal facial analysis to be used regularly in the diagnosis and orthodontic treatment planning.

Facial attractiveness plays a key role in social interaction. 'Smile' is not only a single category of facial behaviour, but also the emotion of frank joy which is expressed on the face by the combined contraction of the muscles involved. When a patient visits the dental clinic for aesthetic reasons, the dentist considers not only the chief complaint but also the overall harmony of the face. This article describes muscle retraining exercises to achieve control over facial movements and improve facial appearance which may be considered following any type of dental rehabilitation. Muscle conditioning, training and strengthening through daily exercises will help to counter balance the aging effects.

Submitted by Cristina Afonso (cac@lisboa.ucp.pt) on 2014-10-20T14:27:56Z No. of bitstreams: 1 COMPARAÇÃO DA PERCEÇÃO ESTÉTICA DA PROEMINÊNCIA MANDIBULAR E DO PERFIL LABIAL ENTRE LEIGOS, ESTUDANTES E PROFISSIONAIS DE~1.pdf: 3471897 bytes, checksum: fe9321ae2e681f1f3127930c7a57d145 (MD5) Approved for entry into archive by Cristina Afonso (cac@lisboa.ucp.pt) on 2014-10-20T14:28:10Z (GMT) No. of bitstreams: 1 COMPARAÇÃO DA PERCEÇÃO ESTÉTICA DA PROEMINÊNCIA MANDIBULAR E DO PERFIL LABIAL ENTRE LEIGOS, ESTUDANTES E PROFISSIONAIS DE~1.pdf: 3471897 bytes, checksum: fe9321ae2e681f1f3127930c7a57d145 (MD5) Made available in DSpace on 2014-10-20T14:28:10Z (GMT). No. of bitstreams: 1 COMPARAÇÃO DA PERCEÇÃO ESTÉTICA DA PROEMINÊNCIA MANDIBULAR E DO PERFIL LABIAL ENTRE LEIGOS, ESTUDANTES E PROFISSIONAIS DE~1.pdf: 3471897 bytes, checksum: fe9321ae2e681f1f3127930c7a57d145 (MD5) Previous issue date: 2014-06

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária Hoje em dia, a estética desempenha um papel determinante na vida de uma pessoa. Um sorriso esteticamente agradável pode aumentar a autoestima e levar a uma melhor aceitação por parte da sociedade. O objetivo principal de um tratamento dentário estético é conceber uma aparência natural e saudável aos dentes. O médico dentista não pode cingir-se à condição de um ou de um grupo de dentes a serem tratados, deve adquirir uma visão mais ampla (macroestética). A macroestética representa as relações entre a face, os lábios, a gengiva e os dentes na obtenção de um resultado estético integral. Para um correto plano de tratamento e conceção de um sorriso ideal e harmonioso é necessário, previamente, uma avaliação detalhada de parâmetros faciais, periodontais e que envolvam dentes em grupo. Porém, os profissionais não devem prender-se totalmente a padrões de estética, devendo apenas utilizá-los como guias para iniciar um plano de tratamento adequado a cada paciente. Foi elaborada uma proposta de checklist / ficha clínica que possa ser utilizada pelo médico dentista para a avaliação do sorriso de um paciente em consultório, de maneira a facilitar o diagnóstico e a elaboração de um plano de tratamento. Desta checklist fazem parte os parâmetros macroestéticos (faciais, periodontais e dentários) mais relevantes abordados ao longo deste trabalho. Os objetivos principais deste trabalho de revisão narrativa contemplam (1) a revisão bibliográfica acerca do tema, (2) a descrição dos parâmetros a avaliar na face, no periodonto e no 2º sextante, quando se pretende a reabilitação estética deste sector, e da forma como estes se relacionam entre si, (3) contextualização da proporção divina a parâmetros faciais e dentários e (4) desenvolvimento de uma checklist com os parâmetros de maneira a ser utilizada na análise de um sorriso. A pesquisa realizada decorreu entre Janeiro e Maio de 2014, recorrendo-se principalmente a uma base de dados, PubMed. Foram utilizadas as seguintes palavras-chave: “aesthetics”, “anterior teeth”, “smile design”, “smile analysis”, “esthetic dentistry”, “golden proportion”, “esthetic parameters”, facial analysis”, “facial aesthetics”, “macroesthetic elements AND smile”, “macroaesthetics”, “gummy smile”, “orthodontics AND smile”, “golden rule”, “divine proportion”, “gingival aesthetics” e “gingival display”, e foram incluídos: (1) artigos publicados nos últimos 14 anos, (2) em língua portuguesa e inglesa, (3) free full text, (4) tipo de artigo: revisão narrativa, revisão sistemática, meta-análise, estudos observacionais e ensaios clínicos. Nowadays, the role of esthetics is determinant in a person’s life. An aesthetically pleasant smile can improve the self-esteem and can lead to a greater society acceptance. The main purpose of a dental esthetic treatment is to conceive a natural and healthy dental appearance. The dentist can’t limit the treatment of one or a group of teeth, he/she must acquire a wider view (macroesthetics). Macroesthetics represent the relations between the face, the lips, the gum and the teeth to obtain a whole esthetic result. To achieve a correct treatment plan and design an ideal and harmonious smile is required, previously, a detailed assessment of facial and periodontal parameters and aspects involving the teeth as a group. However, professionals shouldn’t stick entirely to aesthetical standards, they should use them as guides to initiate a suitable treatment plan for each patient. In this work, it was elaborated a checklist/clinical record proposal that can be used by dentists for the evaluation of patients’ smiles, in order to facilitate the diagnosis and the elaboration of the treatment plan. The macroesthetics parameters (facial, periodontal and dental) developed throughout this work were included in this checklist proposal. The main objectives of this narrative review contemplated: (1) the literature review of the topic, (2) the description of the facial, periodontal and 2nd sextant parameters to evaluate when seeking an esthetic rehabilitation of this sector, and how these parameters relate to each other, (3) contextualization of the divine proportion to facial and dental parameters, (4) development of a checklist with the parameters to be used in the analysis of a smile. The survey coursed between January and May of 2014, resorting mainly to the data base PubMed. The keywords used were: “aesthetics”, “anterior teeth”, “smile design”, “smile analysis”, “esthetic dentistry”, “golden proportion”, “esthetic parameters”, facial analysis”, “facial aesthetics”, “macroesthetic elements AND smile”, “macroaesthetics”, “gummy smile”, “orthodontics AND smile”, “golden rule”, “divine proportion”, “gingival aesthetics” e “gingival display”, and the methodology research included: (1) articles published in the last 14 years, (2) in Portuguese and English, (3) free full text, (4) article type: narrative reviews, systematic reviews, meta-analyzes, observational studies and clinical trials.

Purpose This prospective study was aimed at assessing cleft lip and palate (CLP) patients’ opinions and attitudes towards their upper lip and nose and the number of secondary corrective surgical interventions electively undertaken to upper lip and nose that were carried out during a 2 year follow-up period. Materials and methods During a 2 year follow-up period CLP outpatients were recruited for the study who attended follow-up examinations at a cleft lip and palate craniofacial center and received a recommendation for secondary corrective facial surgery. The participants filled in a questionnaire that included questions regarding the patients’ opinions and attitudes towards appearance of lip and nose and need for secondary corrective facial surgery. During an additional interval of 2 years the rate of patients who underwent secondary corrective surgery to lip and nose was documented. Results Out of 362 CLP patients 37 (mean age 13.6 ± 7.6 years) received a recommendation for secondary corrective surgery to upper lip and/or nose. 22 patients (mean age 12.6 ± 6.3 years) filled in the questionnaire (response rate of 62.1%). The satisfaction with the overall facial appearance following the first corrective operation was statistically significantly better than the satisfaction with the nose (p = .016). The satisfaction with facial symmetry (5.6 ± 2.0) did not differ statistically significantly from the overall satisfaction with the facial appearance (6.2 ± 1.8; p = .093). Significantly fewer patients (n = 9) opted for corrective surgery compared to the number of patients who got the recommendation to have secondary corrective surgery done (n = 22, p

Submitted by Cristina Afonso (cac@lisboa.ucp.pt) on 2014-02-19T16:45:37Z No. of bitstreams: 1 tese Sofia Macedo.pdf: 3985351 bytes, checksum: 9c0271d6cd0086bbc50f489cd7fabe5f (MD5) Approved for entry into archive by Cristina Afonso (cac@lisboa.ucp.pt) on 2014-02-19T16:45:48Z (GMT) No. of bitstreams: 1 tese Sofia Macedo.pdf: 3985351 bytes, checksum: 9c0271d6cd0086bbc50f489cd7fabe5f (MD5) Made available in DSpace on 2014-02-19T16:45:48Z (GMT). No. of bitstreams: 1 tese Sofia Macedo.pdf: 3985351 bytes, checksum: 9c0271d6cd0086bbc50f489cd7fabe5f (MD5) Previous issue date: 2013-07-12

Objectives: Facial Aesthetics, a major consideration in orthodontic diagnosis and treatment planning, may not be judged correctly and completely by simply analyzing dental occlusion or osseous structures. Despite this importance, there is no index to guarantee availability of treatment or prioritize patients based on their soft tissue treatment needs. Individuals having well-aligned teeth but unaesthetic convex profiles do not get included for treatment as per current malocclusion indices. The aim of this investigation is to develop an aesthetic index based on facial profiles which could be used as an additional tool with malocclusion indices. Materials and Methods: A chart showing typical facial profile changes due to underlying malocclusions was generated by soft tissue manipulations of standardized profile photographs of a well-balanced male and female face. A panel of 62 orthodontists judged the profile photographs of 100 patients with different soft tissue patterns for assessing profile variations and treatment need. The index was later tested in a cross-section of school population. Statistical analysis was done using "irr" package of R environment version 2.15.1. Results: The index exhibited very good reliability in determining profile variations (Fleiss kappa 0.866, P < 0.001), excellent reproducibility (kappa 0.9078), high sensitivity, and specificity (95.7%). Testing in population yielded excellent agreement among orthodontists (kappa 0.9286). Conclusions: A new Facial Aesthetic index, based on patient's soft tissue profile requirements is proposed, which can complement existing indices to ensure treatment to those in need.

Obstructive sleep apnea syndrome (OSAS) is defined by the occurrence of abnormally frequent episodes of upper airway obstruction during sleep. This syndrome, which affects about 3% of the adult population, is potentially lifethreatening, increasing cardiovascular problems or accidents due to sleepiness. After defining the therapeutic modalities for OSAS, such as continuous positive airway pressure and lifestyle changes, this thesis focuses on the three areas of mandibular advancement therapy: reversible mandibular advancement by oral appliance (OA), maxillomandibular advancement surgery (MMA), and finally orthopedic treatment of mandibular retrognathia as an interceptive treatment for children and adolescents. The results of original studies are presented: a pilot study to measure the forces generated by OAM in adults (1), the comparison of OA therapy and MMA on a sample of 25 successively treated patients (2), and evaluation of soft tissue profile changes following MMA to determine predictors of final esthetics (3) and specific orthodontic protocols derived from the experience of a 70 patients cohort study (4). Mandibular advancement therapies have many interactions with orthodontics and dento-facial orthopaedics, either in analyzing patient's architectural equilibrium, OA-induced occlusal side effects, or pre-surgical orthodontic preparation. Early treatment of maxillary transversal deficiencies and mandibular retrusion offers opportunities for certain groups of patients, especially when there is a family context of OSAS., On définit le syndrome d'apnées obstructives du sommeil (SAOS) par la survenue d'épisodes anormalement fréquents d'obstruction des voies aériennes supérieures pendant le sommeil. Ce syndrome, qui affecte environ 3% de la population adulte, est potentiellement grave, à l'origine de troubles cardio-vasculaires ou d'accidents imputables à la somnolence. Après avoir défini les modalités thérapeutiques du SAOS, et notamment les traitements de référence (ventilation en pression positive continue, mesures hygiéno-diététiques) cette thèse s'articule autour des 3 axes thérapeutiques du SAOS par avancée mandibulaire : l'avancée mandibulaire réversible, par orthèse (OAM), en tant que traitement symptomatique de l'adulte ; l'avancée maxillo-mandibulaire chirurgicale (AMM), proposée en tant que traitement curatif, et enfin le traitement orthopédique de la rétrognathie mandibulaire, en tant que traitement interceptif chez l'enfant. Les résultats de différentes études originales sont présentés : une étude pilote de mesures des forces générées par l'OAM chez l'adulte (1), la comparaison de l'efficacité de l'OAM par rapport à l'AMM sur un échantillon de 25 patients successivement traités (2), l'évaluation des modifications du profil cutané induites par l'AMM, pour déterminer des facteurs prédictifs du résultat esthétique (3) et la mise au point de protocoles orthodontiques spécifiques préalable à l'AMM, à partir d'une cohorte de 70 patients (4). Le traitement par avancée mandibulaire présente ainsi des interactions nombreuses avec l'orthopédie dento-faciale, que ce soit dans l'analyse de l'équilibre architectural du patient, celle des effets secondaires occlusaux générés par les OAM, ou la préparation orthodontique pré-chirurgicale. Le traitement précoce des endognathies maxillaires et des rétromandibulies offre également des perspectives pour certains groupes de patients apnéiques, notamment quand il existe un contexte familial de SAOS.

Over the past decade, facial cosmetic procedures have become more commonplace ill dentistry and oral and maxillofacial surgery. An increasing number of patients seek minimal invasive procedures. One of the most requested procedures is treatment with botulinum toxin type A (BoNTA). Treatment of dynamic rhytids and lines with BoNTA is effective and produces high rates of improvement with rapid onset and long duration of action (longer than 4 months for some patients) compared with placebo. This paper considers the history and pharmacology of this neurotoxin, and focusses on the literature concerning the treatment of different facial areas with BoNTA. It also presents clinical guidelines on the treatment of glabellar lines, the frontalis muscle, pen-orbital lines, gummy smile and masseter muscle hypertrophy. Knowledge about the mechanisms of action and the ability to use BoNTA as an adjunctive treatment are mandatory for those working in the field of cosmetic facial surgery.

Este artigo compreende a segunda parte da análise facial frontal em fotografias padronizadas. Fizeram parte da amostra estudada 40 mulheres, com idade média de 22 anos, leucodermas, com faces agradáveis, Classe I de Angle, sem história prévia de tratamento ortodôntico e cirurgia plástica na face. Foram obtidas fotografias faciais frontais (10x15cm coloridas), padronizadas. Duas fotografias foram obtidas, no sorriso máximo e durante o repouso. Sobre as fotografias, foram realizadas medidas lineares, angulares e proporcionais. As medidas foram avaliadas por meio de teste de normalidade, estatística descritiva e desvio padrão do erro. Os resultados mostraram que algumas das medidas utilizadas neste trabalho se assemelham às encontradas na literatura e outras diferem muito. E a partir desse estudo propõem-se uma análise facial frontal para utilização rotineira no diagnóstico e planejamento do tratamento ortodôntico. This is the second part of the frontal facial analysis using standardized photographs. The sample consisted of 40 white female with a mean age of 22 years old, pleasant face, normal occlusion, and had not been previously submitted to orthodontic treatment nor plastic surgery. Colorful standardized 10x15 cm photographs were obtained with the patients in their natural head position. Two pictures were taken for each subject, one in maximum smile and another in rest position. Linear, angular and proportional measurements were used. Tests of normality, descriptive statistics, and error standard deviations were executed. The results showed that some of the measurements used in this study have values similar to that found in the literature and some are very different. All of the measurements were reliable after their repetition. And after this study, it is suggested a frontal facial analysis to be used regularly in the diagnosis and orthodontic treatment planning.

Considerando a importância da análise facial frontal no diagnóstico, esse trabalho propõem-se a apresentar uma análise facial frontal em fotografias padronizadas, em repouso e durante o sorriso, que possa auxiliar no diagnóstico e planejamento do tratamento ortodôntico e cirúrgico como também na avaliação dos resultados obtidos. Fizeram parte da amostra estudada 40 mulheres, com idade média de 22 anos, leucodermas, com faces agradáveis, Classe I de Angle, sem história prévia de tratamento ortodôntico e/ou cirurgia plástica na face. Foram obtidas fotografias faciais frontais (10x15cm coloridas), padronizadas. Em repouso e durante o sorriso máximo. Sobre as fotografias, foram realizadas medidas lineares, angulares e proporcionais. As medidas foram avaliadas por meio de teste de normalidade, estatística descritiva e desvio padrão do erro. Os resultados mostraram que algumas das medidas utilizadas em nosso trabalho se assemelham às encontradas na literatura e outras diferem muito. E a partir desse estudo propõe-se uma análise facial frontal para utilização no diagnóstico e planejamento do tratamento ortodôntico e cirúrgico. Considering the importance of the frontal facial analysis in the diagnosis, the purpose of this research is to present a frontal facial analysis using standardized photographs, in rest position and during the smile, as an aid in the diagnosis and planning of the orthodontic and surgical treatment as well as in the evaluation of treatment results. The sample consisted of 40 white female subjects with a mean age of 22 years old, pleasant face, normal occlusion, and had not been previously submitted to orthodontic treatment nor plastic surgery. Colorful standardized 10x15 cm photographs were obtained with the patients in their natural head position. Two pictures were taken for each subject, one in maximum smile and another in rest position. Linear, angular and proportional measurements were used. Tests of normality, descriptive statistics, and error standard deviation were executed. The results showed that some of the measurements used in this study have values similar to that found in the literature and some are very different. All of the measurements were reliable after their repetition. And after this study, it is suggested a frontal facial analysis to be used regularly in the diagnosis and orthodontic treatment planning.

Esta pesquisa visou estabelecer valores normativos, avaliar o dimorfismo sexual entre grandezas cefalométricas e correlacionar médias para avaliação de compensações biológicas que atuem na morfologia do perfil facial de tecidos moles, através das análises cefalométricas computadorizadas de Ricketts e McNamara. A amostragem foi composta por 40 telerradiografias laterais, de indivíduos com perfis esteticamente agradáveis. As radiografias foram analisadas através do programa Radiocef 2.0® nos métodos cefalométricos propostos, e posteriormente foram empregados o teste t de Student e o coeficiente de correlação de Pearson. Nos homens, o comprimento anterior do crânio, comprimento do lábio superior, comprimentos efetivos de maxila e mandíbula, altura facial inferior e diâmetro inferior da faringe foram significativamente mais elevados. Nas mulheres, as médias mais elevadas foram para a extrusão do incisivo inferior e posição labial inferior. A amostra masculina exibiu uma menor altura facial inferior que a média dos valores padrão, mediante aferição linear, em razão do menor comprimento efetivo da mandíbula neste grupo; a mesma correlação não foi significativa para valores angulares. A protrusão labial inferior esteve diretamente relacionada à diferente posição espacial dos incisivos superiores e inferiores em ambas as amostras, na sua relação com os tecidos moles, e respectivas bases ósseas. This research aimed at establishing normative values, evaluating sexual dimorphism between cephalometric measurements, and correlating averages for the evaluation of biological compensations that act in the morphology of the facial soft tissue profile; for these purposes, the computerized cephalometric analyses of Ricketts and McNamara were employed. The sample comprised 40 lateral cephalometric radiographs of individuals with aesthetically pleasant profiles. The radiographs were analyzed through the Radiocef program 2.0®, following the indicated cephalometric methods, and, later, Student's t-test and the coefficient of correlation of Pearson were used. For men, the cranial anterior length, upper lip length, effective midfacial length, effective mandibular length, lower anterior facial height and lower pharynx diameter presented significant higher dimensions. For women, the higher averages found were for the lower incisor extrusion and inferior lip protrusion. The masculine sample exhibited a smaller lower anterior facial height than the standardized averages by linear gauging because of the smallest effective mandibular length in this group; the same correlation was not significant for angular values. In both samples the inferior lip protrusion was directly related to the different spatial position of the upper and lower incisors, in their relation with the soft tissues and respective bony bases.

Aim: to evaluate the possibility of obtaining a good aesthetic result on the face and smile during orthodontic treatment using pre-adjusted appliances. Materials and methods: N=100 patients characterised by gingival recession, “gummy smile”, inadequate gingival line and “smile arc” were treated with the pre-adjusted appliances, using individual positioning of the brackets. An aesthetic analysis was carried out of the facial photograph and lateral cephalograms, taken before (T0) and after (T1) orthodontic treatment. Results: our study showed that for an aesthetic and good orthodontic treatment plan the following are required: individual positioning of the brackets in a strategic way, balancing facial and dental proportions, identifying the patterns of facial growth most “at risk” (long/short face, flat profile, bi-protrusion), obtaining and/or maintaining good “facial balance”, positioning, the lips in a good position with respect to the line of profile, considering the effects of extractive versus non-extractive treatment, the effects of growth, and change in the soft tissue related to the growth, the patient's age. Conclusions: in order to obtain results in cases of gingival recession, “gummy smile”, inadequate gingival line and “smile arc”, this study identified certain factors to bear in mind during diagnosis and treatment planning: an accurate diagnosis, major attention to aesthetic parameters of beauty scientifically tested, individual positioning of the brackets and correct mechanics of treatment.

Aim: to define the modern concept of facial appearance and to correlate this with the evolving trends in facial aesthetics. Materials and methods: to identify the aesthetic trends and fashion from the past up until the present:  a review of orthodontic literature over the last twenty years was carried out;  an analysis of the effect of the “media”: cinema, tv and magazines on the concept of facial appearance. The data collected was related to results of the cephalometrics analysis most up-to-date and most widely used, whether orthodontic or surgical. Results:  The most universally accepted parameters of beauty, which tend to have a considerable influence on the expectations of patients, were extrapolated.  Guidelines were identified when planning the orthodontic treatment in order to achieve a pleasing a esthetic result: facial and dental proportions, facial symmetry, pattern of facial growth, shape/position and fullness of the lips, the relationship between the upper and lower lips, effects of extractive versus non extractive treatment, the effects of growth and changes in the soft tissue related to the growth, the patient's age. Conclusions: our study enabled us to identify modern concept of facial beauty and to evaluate which ones remain universally valid. Guidelines were identify which gave indications for planning orthodontic treatment which, across the mystery of beauty, guided us in obtaining maximum a esthetics in the face and smile.

The impact of extractions on facial aesthetics is one of the most discussed and controversial topics in orthodontics. Clinical evidence and a wide literature show that extractions don’t affect negatively the facial appearance, at condition that diagnosis, treatment planning and treatment mechanics are correct. The impact of extractions on facial aesthetics is one of the most discussed and controversial topics in orthodontics. Clinical evidence and a wide literature show that extractions don’t affect negatively the facial appearance, at condition that diagnosis, treatment planning and treatment mechanics are correct.

Las alteraciones recurrentes de las glándulas submaxilares son unos trastornos relativamente frecuentes que se deben, generalmente, a una enfermedad obstructiva de la glándula, entre otras menos frecuentes, como la presencia de neoplasias, enfermedades autoinmunes o degenerativas. El tratamiento quirúrgico habitual consiste en la exéresis de la glándula submaxilar a través de un abordaje cervical. Las ventajas de este abordaje cervical son su sencillez, la visión directa del campo quirúrgico y la rapidez del procedimiento. Las desventajas más relevantes son la cicatriz cervical y la posibilidad de lesión de la rama marginal del nervio facial. Se presenta y discute el abordaje intraoral como acceso a la glándula submaxilar. Su ventaja respecto al abordaje convencional es la eliminación de la cicatriz cervical y el riesgo de lesión de la rama marginal. Sus desventajas fundamentales son la dificultad técnica, la visión reducida, el mayor tiempo quirúrgico empleado y la posibilidad de lesión del nervio lingual. En el Hospital Universitario de Canarias (Tenerife, España), a un total de 6 pacientes, 4 mujeres y 2 varones entre 25 y 60 años, se les realizó una submaxilectomía por abordaje intraoral. En todos los casos los resultados estéticos y funcionales fueron muy satisfactorios, tan solo leves disestesias del nervio lingual autolimitadas en 2 meses. Se presenta una alternativa por vía intraoral al abordaje cervical para la realización de submaxilectomía, con la ventaja principal de eliminar la cicatriz cervical. Recurrent sub-maxillary gland disorders are relatively common. They are mainly caused by obstructive gland diseases. Other aetiologies are malignancies, autoimmune, or degenerative diseases. The traditional treatment of the submandibular gland is the surgical excision by a cervical approach. The advantages of this approach are: its simplicity, direct surgical vision, and speed of the procedure. The most important disadvantages are: unsightly cervical scar, and injury risk of the marginal branch of the facial nerve. This paper presents and discusses the intraoral approach to the submandibular gland. The advantages over the conventional approach are: the elimination of the scar and the risk of injury to the marginal branch. The main disadvantages are: the technical difficulty, reduced vision, the longer surgical time, and the possibility of lingual nerve injury. A total of 6 patients, 4 women and 2 men aged 25 to 60 years, underwent a sub-maxillectomy by intraoral approach in the Hospital Universitario de Canarias (Tenerife, Spain). In all cases, the aesthetic and functional results were very satisfactory, with only mild self-limited lingual nerve dysesthesia being observed at two months. We present an alternative to the cervical approach for the submandibular glands; the intraoral approach. The major advantage of this technique is to eliminate the cervical scar.

Se realizó un estudio epidemiológico analítico, de casos y controles, para identificar los principales factores asociados al abandono del tratamiento ortodóncico en el Servicio de Ortodoncia de la Clínica Estomatológica Provincial Docente “Mártires del Moncada” de Santiago de Cuba, en el período comprendido desde septiembre de 2010 hasta julio de 2013. Para ello se crearon 2 grupos: el de los casos, integrado por 193 pacientes de uno u otro sexo, que habiendo iniciado el tratamiento ortodóncico en 2008 por presentar maloclusiones, lo abandonaron en 2010; y el de los controles, conformado por 193 que lo comenzaron también en 2008, pero lo finalizaron en 2010 o 2011. Entre las variables utilizadas figuraron: edad, sexo, escolaridad y consultas no asistidas. Se obtuvo un predominio de los varones (55,4 %), del abandono del tratamiento por los escolares (72,0 %), del menor nivel de escolaridad (88,6 %) y de la asistencia a menos de 6 consultas (54,9 %).

La estética y armonía facial se relacionan de forma directa con la percepción y autoestima de los individuos; muchas veces se generan deseos de cambios estéticos por medio de cirugías para obtener una valoración positiva de sí mismo. El objetivo de este estudio fue investigar la relación entre la percepción, autoestima y deseo de cambio estético; y puntos antropométricos, cefalométricos y maloclusiones de un grupo de mujeres. Se escogieron 29 mujeres chilenas, entre 20 y 25 años de edad, en las cuales se realizó una encuesta sobre la autoestima, autopercepción de normalidad facial, deseo de cambio estético y cambio de autoestima posterior a una cirugía, éstas se asociaron a través de un análisis de chi2, regresión logística de multivariado y ANOVA, con las distancias entre puntoantropométricos objetivos basados en estudios de Farkas y entre puntos cefalométricos basados en Epker y Fish; y entre ellas a través de un análisis. La normalidad facial se ve afectada principalmente por clases caninas derecha (p=0,02) e izquierda (p=0,015) y molares derecha (p=0,015) e izquierda (p=0,04); y además el apiñamiento dentario (p=0,012). Mientras el aumento en la distancia de exocantios (p=0,04), bases alares (p=0,03), proporción glabela subnasal y subnasal mentón (p=0,02) se asocian a una percepción de anormalidad. La autoestima puede variar de forma positiva posterior a un cambio estético, a través de cirugía o tratamiento de ortodoncia. Los parámetros dentomaxilares y craneofaciales son determinantes en la percepción de normalidad estética de estas mujeres, siendo los relacionados con nariz y altura facial los de mayor influencia en este estudio. Son necesarios futuros estudios para evaluar autoestima, autopercepción de normalidad facial y proporciones estéticas. Aesthetics and facial harmony are directly related to self-esteem and perception individuals have of themselves. There is often a desire to make overall aesthetic changes through surgery in order to get a positive assessment of oneself. The aim of this study was to research the relationship between perception, self-esteem and desire for change; and points aesthetic anthropometric and cephalometric points, as well as malocclusions in a group of women. Twenty nine (29)Chilean women between 20 and 25 years of age were chosen, taking part in a survey on self-esteem, self-perception of facial normalcy, the desire for aesthetic change, and changes of self-esteem following surgery. These were subsequently associated through Chi2 analysis, logistic multi variant regression and ANOVA, with distances between objective anthropometric marks based on Farkas research, and between cephalometric points based in Epker and Fish study. Facial normalcy seems mainly affected by right canine class (p=0.02), and left (p=0.015); right molar class (p=0.015) and left (p=0.04), as well as dental crowding (p=0.012). While greater exocanthion distance (p=0.04), alar base (p=0.03), subnasal glabella and subnasal menton ratios (p=0.02), are related to a perception of abnormality. Self esteem perception can vary in positive ways following an aesthetic change through surgery or orthodontic treatment. Dental, maxillary and craniofacial parameters are determinants of the aesthetic normalcy perception of these women, with nose and facial height having the most influence in this study. Further research is necessary to evaluate self- esteem and self perception of facial normalcy, as well as aesthetic ratios.