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Alterações cefalométricas após disjunção maxilar (palatina) em pacientes portadores de maloclusão de classe III de Angle: evidências revisadas
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Abstract(s)
As alterações cefalométricas após a disjunção maxilar em pacientes portadores de Classe III de Angle é um tema abordado por uma série de artigos científicos. Este trabalho visa realizar uma revisão sistemática sobre o tema.
Objetivo: Agrupar sob forma de revisão sistemática informações relativas aos ensaios clínicos randomizados (ECR) que discorrem sobre as alterações cefalométricas observadas após a disjunção maxilar em pacientes classe III de Angle.
Método: Através da estratégia de pesquisa PICO, foram selecionados ECRs utilizando- se as bases de dados Scopus, PubMed, Cochrane e Web ofScience. Os critérios de inclusão na seleção de artigos foram: artigos em língua inglesa e cujos pacientes das amostras fossem portadores de maloclusão de classe III de Angle com constrição maxilar, crianças e adolescentes de acordo com o critério definido pela Organização Mundial da Saúde (OMS), e ao menos um dos grupos randomizados deveria ter como intervenção a disjunção maxilar e a aferição das alterações cefalométricas observadas após a expansão palatina. Estudos do tipo crossover foram incluídos igualmente de modo condicional à existência da intervenção da disjunção maxilar e análise da cefalometria. A recolha dosdados e triagem dos ECRs foi feita em três etapas utilizando-se o título, o abstract e o texto completo do artigo, nesta ordem. Ao fim da última etapa do processo de triagem os artigos elegíveis foram submetidos a uma análise do risco de viés e qualidade da evidência científica.
Resultados: Após a triagem 16 artigos elegíveis foram selecionados, com total de 650 pacientes com idade média de 8,76 anos, sendo que 233 são do sexo masculino e 354 do sexo feminino. Dos 16 artigos finais 56% são do tipo braços paralelos e 44% são do tipo crossover uni ou bilaterais. Dos dados cefalométricos recolhidos destaca-se como resultado da disjunção palatina que a maxila desloca-se no sentido anterior e inferior, comprovado pelo aumento do ângulo SNA, deslocamento anterior do ponto A, profundidade maxilar além de outras alterações cefalométricas. Na mandíbula pode-se constatar a diminuição dos ângulos SNB e eixo facial o que comprova a rotação mandibular no sentido horário. Devido a esta movimentação das bases ósseas uma melhoria no perfil facial e um aumento da dimensão vertical foi verificadaatravés do aumento dos ângulos ANB, altura facial inferior, ângulo do plano mandibular e Wits.
Em relação às alterações dentárias é possível constatar um aumento do overjet, uma proinclinação dos incisivos superiores e uma retro inclinação dos incisivos inferiores, com aumento do U1. NA e diminuição do L1.NB.
Conclusão: A disjunção maxilar associada ao uso de máscara facial em pacientes portadores de maloclusão de classe III de Angle é uma opção de tratamento viável, contudo recomenda-se que novas revisões, qualitativas e metanalíticas, sejam realizadas com a publicação de novos ensaios clínicos randomizados para que se possam perceber resultados mais precisos e com maior poder de evidência.
Cephalometric changes after maxillary disjunction in Angle Class III patients are a topic addressed by a series of scientific articles. This work aims to carry out a systematic review on the topic. Objective: Agroup in the form of a systematic review information related to randomized clinical trials (RCT) that discuss the cephalometric changes observed after maxillary disjunction in Angle class III patients. Method: Through the PICO research strategy, RCTs were selected using Scopus, PubMed, Cochrane and Web of Science databases. The inclusion criteria in the selection of articles were: articles in English and whose patients in the samples had Angle class III malocclusion with maxillary constriction, children and adolescents according to the criteria defined by the World Health Organization (WHO), and at least one of the randomized groups should have maxillary disjunction and the measurement of cephalometric changes observed after palatal expansion as intervention. Crossover studies were also included conditionally on the existence of maxillary disjunction intervention and cephalometric analysis. The collection of data and screening of RCTs was done in three stages using the title, the abstract and the full text of the article, in that order. At the end of the last stage of the screening process, eligible articles were subjected to an analysis of the risk of bias and quality of scientific evidence. Results: After screening, 16 eligible articles were selected, with a total of 650 patients with an average age of 8.76 years, of which 233 are male and 354 female. Of the 16 final articles, 56% are of the parallel arms type and 44% are of the uni or bilateral crossover type. From the cephalometric data collected, it stands out as a result of the palatal disjunction that the maxilla moves in the anterior and inferior direction, evidenced by the increase in the SNA angle, anterior displacement of point A, maxillary depth and other cephalometric changes. In the mandible, there is a decrease in the SNB angles and facial axis, which proves the mandibular rotation in a clockwise direction. Due to this movement of the bone bases, an improvement in the facial profile and an increase in the vertical dimension ware observed, evidenced by increased ANB angles, lower facial height, angle of the mandibular plane and Wits. Regarding dental changes, it is possible to observe an increase in overjet, a forward inclination of the upper incisors and upright movement of the lower incisors, with an increase in U1.NA and decrease in L1.NB. Conclusion: The maxillary disjunction associated with the use of a face mask in patients with Angle class III malocclusion is a viable treatment option, however it is recommended that further qualitative and meta-analytical reviews be carried out with the publication of new randomized clinical trials so that more accurate results with greater power of evidence can be perceived.
Cephalometric changes after maxillary disjunction in Angle Class III patients are a topic addressed by a series of scientific articles. This work aims to carry out a systematic review on the topic. Objective: Agroup in the form of a systematic review information related to randomized clinical trials (RCT) that discuss the cephalometric changes observed after maxillary disjunction in Angle class III patients. Method: Through the PICO research strategy, RCTs were selected using Scopus, PubMed, Cochrane and Web of Science databases. The inclusion criteria in the selection of articles were: articles in English and whose patients in the samples had Angle class III malocclusion with maxillary constriction, children and adolescents according to the criteria defined by the World Health Organization (WHO), and at least one of the randomized groups should have maxillary disjunction and the measurement of cephalometric changes observed after palatal expansion as intervention. Crossover studies were also included conditionally on the existence of maxillary disjunction intervention and cephalometric analysis. The collection of data and screening of RCTs was done in three stages using the title, the abstract and the full text of the article, in that order. At the end of the last stage of the screening process, eligible articles were subjected to an analysis of the risk of bias and quality of scientific evidence. Results: After screening, 16 eligible articles were selected, with a total of 650 patients with an average age of 8.76 years, of which 233 are male and 354 female. Of the 16 final articles, 56% are of the parallel arms type and 44% are of the uni or bilateral crossover type. From the cephalometric data collected, it stands out as a result of the palatal disjunction that the maxilla moves in the anterior and inferior direction, evidenced by the increase in the SNA angle, anterior displacement of point A, maxillary depth and other cephalometric changes. In the mandible, there is a decrease in the SNB angles and facial axis, which proves the mandibular rotation in a clockwise direction. Due to this movement of the bone bases, an improvement in the facial profile and an increase in the vertical dimension ware observed, evidenced by increased ANB angles, lower facial height, angle of the mandibular plane and Wits. Regarding dental changes, it is possible to observe an increase in overjet, a forward inclination of the upper incisors and upright movement of the lower incisors, with an increase in U1.NA and decrease in L1.NB. Conclusion: The maxillary disjunction associated with the use of a face mask in patients with Angle class III malocclusion is a viable treatment option, however it is recommended that further qualitative and meta-analytical reviews be carried out with the publication of new randomized clinical trials so that more accurate results with greater power of evidence can be perceived.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Odontologia Classe III Angle Cefalometria Disjunção palatina