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Master's Dissertation
DOI
10.11606/D.25.2018.tde-02102018-210559
Document
Author
Full name
Bruno Gomes Duarte
Institute/School/College
Knowledge Area
Date of Defense
Published
Bauru, 2018
Supervisor
Committee
Gonçales, Eduardo Sanches (President)
Assis, Diogo Souza Ferreira Rubim de
Júnior, Osny Ferreira
Pereira Filho, Valfrido Antonio
Title in Portuguese
Estudo comparativo dos efeitos dento-esqueléticos maxilares e mandibulares da expansão de maxila cirurgicamente assistida
Keywords in Portuguese
Mandíbula
Maxila
Técnica de expansão palatina
Tomografia computadorizada por raios X
Abstract in Portuguese
A expansão rápida de maxila assistida cirurgicamente (ERMAC) é uma das formas de tratamento para a deficiência transversal de maxila. Essa técnica depende do uso de dispositivos expansores, os quais podem ter relação com a movimentação dos dentes superiores, não existindo estudos que apontem alterações dos dentes inferiores. O presente trabalho teve como objetivo mensurar a movimentação dos dentes superiores e inferiores, produzidas pela ERMAC, por meio de técnicas cirúrgicas com diferentes tipos de corticotomias da parede anterior da maxila. O estudo foi composto 87 exames de tomografia computadorizada por feixe cônico (TCFC), sendo esses divididos de acordo com o osteotomia realizada: Grupo I (n= 42) osteotomia do tipo Le Fort I subtotal com degrau no pilar zigomático-maxilar e Grupo 2 (n = 45) osteotomia do tipo Le Fort I subtotal com osteotomia linear descendente. Os períodos avaliados foram divididos em: pré-operatório (T0), após o término da ativação do dispositivo expansor (T1) e período de contenção ortodôntica (T2). Os dados foram tabulados, comparados entre os períodos estudados e analisados estatisticamente por meio da análise de variância para medidas repetidas (ANOVA) e Teste de Tukey para comparação entre os três tempos, nos quais foram avaliados o total de pacientes (GI+GII) e cada grupo isoladamente (GI) (GII). Os resultados demonstraram aumento estatisticamente significativo das dimensões maxilares, além a inclinação vestibular dos dentes 13, 23, 16 e 26, em ambos os grupos; observaram-se efeitos dentoesqueléticos mandibulares na largura da cortical lingual, aumento da distância entre os ápices dos dentes 46 e 36 e inclinação vestibular do dente 36. Porém, somente esse último foi estatisticamente significante (p < 0,05). Isso nos permitiu concluir que, em procedimentos de expansão rápida de maxila assistida cirurgicamente são verificados efeitos dento-esqueléticos predominantemente maxilares, mas podem ocorrer efeitos mandibulares, sendo esses sem significância estatística.
Title in English
Measurement of maxillary and mandibular dento-skeletal effects resulting from surgically assisted rapid maxillary expansion
Keywords in English
Mandible
Maxilla
Palatal expansion technique
Tomography, X-ray computed
Abstract in English
Surgically assisted rapid maxillary expansion (SARME) is the main treatment option for transverse maxillary deficiency in adults. This technique depends on the use of expanders, which are commonly related to the movement of teeth in the maxilla, however, there are no studies analyzing the occurrence of alterations in the lower teeth to this date. The aim of this study was to assess the movement of upper and lower teeth produced by SARME executed by means of two surgical techniques with different types of corticotomies on the anterior wall of the maxilla. The sample consisted of 87 cone beam computed tomography (CBCT) scans, which were divided in two groups according to the osteotomy performed: Group I (n = 42) Le Fort I subtotal osteotomy with a step on the zygomatic-buttress and Group 2 (n = 45) Le Fort I type subtotal osteotomy with a linear descending osteotomy of the maxilla. The time periods evaluated were divided into: preoperative (T0), immediately after activation of the expander device was ceased (T1) and ending of orthodontic containment period (T2). The data were tabulated and compared between the periods studied and statistically analyzed by means of analysis of variance for repeated measurements (ANOVA) and Tukey's test for comparison between the three time periods. The total number of individuals (GI + GII) and each isolated group (GI) (GII) were analyzed. The results showed a statistically significant increase of all the maxillary dimensions associated with buccal inclination of the teeth 13, 23, 16 and 26 in both groups; mandibular dentoskeletal effects on the width of the lingual cortex were observed, there was also an increased distance between the apexes of teeth 46 and 36, and buccal inclination of the tooth 36 were noted, however, only the latter was statistically significant (p <0.05). This has allowed us to conclude that, in procedures of surgically assisted rapid maxillary expansion, dento-skeletal effects are predominantly maxillary, but mandibular effects may also occur, mainly without statistical significance.
 
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Publishing Date
2018-10-05
 
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