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O presente artigo aborda o trabalho de aproximação facial forense de uma vítima da Batalha de Gotland, ocorrida em 1361 na ilha de mesmo nome, localizada na Suécia. Além de reconstruir o aspecto do indivíduo em vida, o trabalho buscou apresentar o ferimento recebido por um objeto cortante, ao ser golpeado na região frontal da face.

The primary correction of congenital complete unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) is challenging due to inherent lack of palatal tissue and small extent of the palatal shelves at birth. The tissue deficiency affects the nasal mucosa, maxillary bone and palatal mucosa. This condition has driven the evolution of several surgical and non-surgical techniques for mitigating the inherent problem of anatomical deficits. These techniques share the common principle of altering the neighboring tissues around the defect area in order to form a functional seal between the oral and nasal cavity. However, there is currently no option for rectifying the tissue deficiency itself. Investigations have repeatedly shown that despite the structural tissue deficiency of the cleft, craniofacial growth proceeds normal if the clefts remain untreated, but the cleft remains wide. Conversely, craniofacial growth is reduced after surgical repair and the related alteration of the tissues. Therefore, numerous attempts have been made to change the surgical technique and timing so as to reduce the effects of surgical repairs on craniofacial growth, but they have been only minimally effective so far. We have determined whether the intrinsic structural soft and hard tissue deficiency can be ameliorated before surgical repair using the principles of periosteal distraction by means of magnetic traction. Two three-dimensional maxillary finite element models, with cleft patterns of UCLP and BCLP, respectively, were created from computed tomography slice data using dedicated image analysis software. A virtual dental magnet was positioned on either side of the cleft at the mucoperiosteal borders, and an incremental magnetic attraction force of up to 5 N was applied to simulate periosteal distraction. The stresses and strains in the periosteal tissue induced by the magnet were calculated using finite element analysis. For a 1 N attraction force the maximum strains did not exceed 1500 &micro, strain suggesting that adaptive remodeling will not take place for attraction forces lower than 1 N. At 5 N the regions subject to remodeling differed between the UCLP and BCLP models. Stresses and strains at the periosteum of the palatal shelf ridges in the absence of compressive forces at the alveolar borders were greater in the UCLP model than the BCLP model. The findings suggest that in newborns with UCLP and BCLP, periosteal distraction by means of a magnetic 5 N attraction force can promote the generation of soft and hard tissues along the cleft edges and rectify the tissue deficiency associated with the malformation.

Background: Adult patients presenting with skeletal discrepancies may refuse surgical intervention. Materials and methods: Thirty-two patients who declined orthognathic correction of their maxillo-mandibular dysplasia and who were without signs of temporomandibular dysfunction (TMD) were offered mandibular repositioning as a non-invasive alternative. Simulating a skeletal correction, it was explained that the approach was based on results described in case reports. Before commencing treatment, initial records, lateral and frontal head films, study casts and photos were obtained (T0) and the mandible was repositioned to camouflage a retrognathic skeletal discrepancy or a mandibular transverse asymmetry by means of an occlusal build-up using Triad™ gel. Results: Three months later (T1), 23 patients had adapted to the new occlusion reflected by an absence of functional disturbance and without fracture of the composite occlusal build-up. Mandibular position in these patients was maintained by additional orthodontic treatment and an adjustment of the occlusion to the built-up postured position (T1). The skeletal changes occurring during repositioning were assessed on sagittal and frontal head films while intra-articular changes occurring during a two-year follow-up period (T2) were evaluated on images constructed from CBCT scans. No significant change, either in the direction of relapse or in the direction of further normalisation of condylar position, were observed during the two-year observation period. Conclusion: Mandibular repositioning is a non-invasive intervention that may be considered a valid alternative to surgery in selected patients. Morphological variables from the radiographs taken at T0 and the results of the initial clinical evaluation of dysfunction yielded only vague and insignificant indicators regarding the predictability of the adaptation. A CBCT scan at T0 might have contributed to the identification of the patients who would likely accept the repositioning.

INTRODUCTION:Skeletal anchorage was not introduced as an alternative to conventional anchorage modalities. The first skeletal anchorage was a ligature through a hole in the infrazygomatic crest. This was replaced by surgical screws and finally the TADs, which were optimized with respect to the material and morphology, were developed. A bracket-like head allows for the use of the mini-implant as indirect anchorage, but should not be a tool for lost control resulting from badly planned biomechanics or failing compliance. Skeletal anchorage should serve as an adjunct to correct biomechanics, to enable treatments that could not be performed prior to the introduction of skeletal anchorage.MATERIALS AND METHODS:The aim of this study was to test the hypothesis that temporary anchorage mini-screws help maintain bone density, height and width of alveolar processes in the extraction sites, and thus prevent the thinning of the alveolar ridge usually observed.RESULTS:In adult patients with degenerated dentitions the application of skeletal anchorage can allow for the displacement of teeth where no anchorage units are present, but also for the redevelopment and maintenance of atrophic alveolar bone. The basis for the optimal use of skeletal anchorage is that the correct line of action for the desired tooth displacement is defined and the necessary force system constructed either with the skeletal anchorage as direct or as indirect anchorage. After a period, during which osseointegrated implants were used as anchorage for tooth movement and bone maintenance, it was accepted that the mini-implants could serve also as anchorage for skeletal displacements avoiding loading of teeth.

AIMS:The aim of the study was to assess the degree of and correlation between facial hard and soft tissue asymmetry in patients with juvenile idiopathic arthritis, identify valid soft tissue points for clinical examination and assess the smallest clinical detectable level of dentofacial asymmetry. MATERIAL AND METHODS:Twenty-one juvenile idiopathic arthritis patients diagnosed according to the ILAR criteria participated in the study. Full-face cone-beam computed tomography scans and 3D photographs were used to measure and assess facial hard and soft tissue asymmetry with regression analysis. A survey of thirteen postgraduate orthodontic residents and five senior staff members of the Aarhus University’s Section of Orthodontics was also conducted to assess how asymmetry is observationally perceived based on cone-beam computed tomography scans and 3D photographs. Descriptive statistics was applied for the presentation of the survey results. RESULTS: Significant linear correlation was found between the hard and soft tissue gonia deviations at both the transverse and vertical positions (R2=0.486 and R2=0.535), while transverse asymmetries of the pogonion presented high correlation (R2=0.786). The occlusal plane canting and the vertical difference of the cheilion were correlated (R2=0.349). The occlusal plane canting was also correlated to the vertical asymmetry of the zygomatic processes (R2=0.470), while it was found to coincide with vertical hard tissue gonion deviations (R2=0.564). Transverse and vertical positions of the soft tissue gonion and cheilion were correlated (R2=0.313 and R2=0.446). Among medial soft tissue points, glabella was found to present the smallest deviation and the pogonion the largest deviation from the midsagittal plane. The participants’ assessment of hard and soft tissue deviations in the survey was found to be in agreement with linear measurements when deviation exceeded ±2 mm. CONCLUSION: Facial asymmetries are most pronounced at the lower facial third. Soft tissue pogonion and gonion were identified as the most appropriate landmarks to clinically assess the presence of facial asymmetry. Professionals can accurately identify asymmetry when this exceeds 2 mm.

Edward Angle lag richtig mit seiner Feststellung, dass die ersten Molaren als Schlüssel der Okklusion angesehen werden können.Die virtuelle Okklusion ist innerhalb der Kieferorthopädie und darüber hinaus ein vielseitiges Werkzeug, um die Okklusionskontakte zu quantifizieren und digital zu archivieren. Sie ist zugleich die Grundlage für biomechanische Simulationen und Analysen.

Cleft lip and palate are the most common craniofacial malformations, affecting one in every 500 to 700 live births, thus accounting for about 220,000 new cases each year worldwide with tremendous variations across geographic areas, ethnic groups and socioeconomic status. Affected children have a range of both functional and aesthetic problems comprising of feeding difficulties due to incomplete oral seal, swallowing, nasal regurgitation, respiratory problems, hearing difficulties due to abnormalities in the palatal musculature, and speech impairments due to air escape and articulations problems. The surgery can solve the problems, but the two major factors which determine a good surgical outcome and its assessment are the interpretation of the actual size of the cleft and generation of periosteal tissue to close the defect. The surgeons faced a challenge to measure the cleft size due to wide diversity in methodologies employed which resulted in improper estimation of the deficient palatal tissue and thus resulted contradictory results in measuring outcomes such as occlusion or midface skeletal development. We have introduced the vomer edge for establishing a validated 3D measuring method for the width, area and height of the true cleft with reproducible landmarks for easy and accurate measurement of the outcomes in unilateral cleft lip and palate patients. The passive plate therapy provided to UCLP patients gave favourable anatomical conditions for subsequent surgical palatal repair in patients by alleviating the problems of tissue deficiency to some extent. We therefore adopted periosteal tissue distraction osteogenesis as potential treatment strategy to target the tissue deficiency while using the magnetic forces to exert necessary strain. In our study, we have assessed whether the dental magnets have the potential to act as a device to generate mucoperiosteal tissue in UCLP. We have used in-silica approach in the form of 3D FE-model and found that strain levels in the palatal segments of the cleft for the load cases do reach 1500 µstrain limit, a requirement for bone formation, according to the mild overload window of the Mechanostat theory proposed by Harold Frost. We further examined the forces, which reach threshold for regeneration of the hard and soft tissue volumes along the cleft edges in both UCLP and BCLP by means of periosteal distraction. We found that a 5N attraction force could initiate generation of soft and hard tissues along the cleft edges in in-silico model within the optimal biological limits.