Avaliação a longo prazo dos efeitos do tratamento com o aparelho de Herbst seguido de Ortodontia fixa
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Data
2020-07-22
Autores
Marchi, Paulo Guilherme Bittencourt [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
O objetivo deste estudo foi avaliar longitudinalmente os efeitos dentários, esqueléticos e no perfil facial, causados pela terapia com o aparelho de Herbst, seguida de aparelho fixo. A amostra foi composta por telerradiografias em norma lateral e modelos de 61 pacientes portadores de Classe II, divisão 1ª, em fase de surto de crescimento puberal. A amostra foi dividida em: Grupo Tratado (GT), 33 pacientes tratados com o aparelho de Herbst, seguido de aparelho fixo e acompanhados, em média, por 4 anos após o término do tratamento ortodôntico; Grupo Controle (GC), 28 pacientes acompanhados por 12 meses. Telerradiografias em norma lateral foram obtidas em: T1, antes da instalação do Herbst (GT) ou no início do período de acompanhamento (GC); T2, após o tratamento com Herbst (GT) ou após o período de acompanhamento (GC); T3, após a remoção do aparelho fixo (GT); T4, em média, 4 anos após o término do tratamento ortodôntico (GT). Os modelos foram avaliados em T1, T2 e T3. Testes paramétricos e não-paramétricos foram utilizados para a análise estatística. Comparado ao GC, a avaliação do perfil facial do GT (T1-T2) mostrou: diminuição da convexidade facial, protrusão do lábio inferior e do pogônio tegumentar, aumento da altura facial ântero-inferior e do ângulo do sulco mentolabial. A avaliação dentoesquelética do GT (T1-T2) mostrou: retroinclinação do incisivo superior, proclinação do incisivo inferior, distalização do molar superior, mesialização do molar inferior, aumento do comprimento mandibular, diminuição do overjet, melhora na relação sagital de molar e protrusão mandibular. A avaliação dos modelos do GT (T1-T2) mostrou: aumento do perímetro e da largura das arcadas dentárias, melhora nas relações sagitais de canino e molar, diminuição do overjet e do overbite. Na avaliação longitudinal do perfil facial do GT (T1-T4), houve: retrusão do lábio superior e do sulco superior, e aumento do ângulo do sulco mentolabial e do terço anterior inferior facial. Na avaliação dentoesquelética do GT, houve manutenção longitudinal das alterações ocorridas entre T1 e T2 no incisivo inferior, incisivo superior, molar inferior, molar superior, overjet, maxila e mandíbula. A avaliação longitudinal de modelos (T1-T3) do GT mostrou: melhora nas relações sagitais de molar e canino, do overbite, overjet, índice de irregularidade, e um aumento na largura intercanina superior. Como conclusões, constatou-se que a maior parte das alterações dentárias, esqueléticas e no perfil facial causadas pelo tratamento com o aparelho de Herbst, se mantiveram após o tratamento com o aparelho fixo e 4 anos após o término do tratamento ortodôntico. Apesar da efetividade na correção da Classe II, houve manutenção da característica de convexidade facial.
The aim of this study was to evaluate longitudinally the dental, skeletal and soft tissue profile changes, promoted by Hertbst therapy, followed by fixed appliances. The sample consisted of lateral cephalometric headfilms and dental casts of 61 Class II, division 1, patients, at the pubertal growth spurt. The sample was divided into two groups: Treated Group (TG), 33 patients treated with Herbst appliance, fixed appliances and followed up, on average, for 4 years after the end of the orthodontic treatment; Control Group (CG), 28 patients followed up for 12 months. The lateral radiographs were obtained at: T1, before placement of Herbst (TG) or at the beginning of the follow-up period (CG); T2, after Herbst therapy (TG) or after the follow-up period (CG); T3, at the end of fixed appliances therapy (TG); T4, on average, 4 years after the end of the orthodontic treatment (TG). Dental casts were analyzed at T1, T2 and T3. Parametric and non-parametric tests were used for statistical analysis. Compared to CG, the evaluation of the soft tissue profile in TG (T1-T2) showed : decreased facial convexity, protrusion of the lower lip and pogonion, increased lower anterior facial height and labiomental angle. The dentoskeletal evaluation of the TG (T1-T2) showed: upper incisor retroinclination, lower incisor proclination, upper molar distalization, lower molar mesialization, increased mandibular length, decreased overjet, improved molar sagittal relationship, and mandibular protrusion. The evaluation of the dental casts (T1-T2) in TG showed: increased arches perimeter and width, improved canine and molar sagittal relationships, decreased overjet and overbite. In TG longitudinal evaluation (T1-T4), the soft tissue profile showed: retrusion of upper lip and superior sulcus, and increase in labiomental angle and in lower anterior facial height. In TG longitudinal dentoskeletal evaluation, the changes presented between T1 and T2 by lower incisor, upper incisor, lower molar, upper molar, overjet, maxilla and mandible were maintained at T4. The TG longitudinal evaluation of the dental casts (T1-T3) showed: improved overbite, overjet, irregularity index, molar and canine sagittal relationships, and an increase in upper intercanine arch width. As conclusion, it was found that most of dental, skeletal and soft tissue profile changes promoted by Herbst therapy, were mantained after fixed appliances and, on average, 4 years after the end of the orthodontic treatment. Despite the effectiveness in Class II correction, facial convexity characteristic was maintained.
The aim of this study was to evaluate longitudinally the dental, skeletal and soft tissue profile changes, promoted by Hertbst therapy, followed by fixed appliances. The sample consisted of lateral cephalometric headfilms and dental casts of 61 Class II, division 1, patients, at the pubertal growth spurt. The sample was divided into two groups: Treated Group (TG), 33 patients treated with Herbst appliance, fixed appliances and followed up, on average, for 4 years after the end of the orthodontic treatment; Control Group (CG), 28 patients followed up for 12 months. The lateral radiographs were obtained at: T1, before placement of Herbst (TG) or at the beginning of the follow-up period (CG); T2, after Herbst therapy (TG) or after the follow-up period (CG); T3, at the end of fixed appliances therapy (TG); T4, on average, 4 years after the end of the orthodontic treatment (TG). Dental casts were analyzed at T1, T2 and T3. Parametric and non-parametric tests were used for statistical analysis. Compared to CG, the evaluation of the soft tissue profile in TG (T1-T2) showed : decreased facial convexity, protrusion of the lower lip and pogonion, increased lower anterior facial height and labiomental angle. The dentoskeletal evaluation of the TG (T1-T2) showed: upper incisor retroinclination, lower incisor proclination, upper molar distalization, lower molar mesialization, increased mandibular length, decreased overjet, improved molar sagittal relationship, and mandibular protrusion. The evaluation of the dental casts (T1-T2) in TG showed: increased arches perimeter and width, improved canine and molar sagittal relationships, decreased overjet and overbite. In TG longitudinal evaluation (T1-T4), the soft tissue profile showed: retrusion of upper lip and superior sulcus, and increase in labiomental angle and in lower anterior facial height. In TG longitudinal dentoskeletal evaluation, the changes presented between T1 and T2 by lower incisor, upper incisor, lower molar, upper molar, overjet, maxilla and mandible were maintained at T4. The TG longitudinal evaluation of the dental casts (T1-T3) showed: improved overbite, overjet, irregularity index, molar and canine sagittal relationships, and an increase in upper intercanine arch width. As conclusion, it was found that most of dental, skeletal and soft tissue profile changes promoted by Herbst therapy, were mantained after fixed appliances and, on average, 4 years after the end of the orthodontic treatment. Despite the effectiveness in Class II correction, facial convexity characteristic was maintained.
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Palavras-chave
Ortodontia, Má oclusão de Angle Classe II, Estabilidade, Orthodontics, Malocclusion Angle class 1, Stability