Acurácia tridimensional do planejamento virtual de cirurgia ortognática em pacientes classe III tratados com alinhadores ortodônticos: ensaio clínico controlado

• Ano de defesa: 2024
• Autor(a) principal: Amaro, Luana Karine
• Outros Autores: [e-mail]
• Orientador(a): Miguel, José Augusto Mendes
• Banca de defesa: Carvalho, Felipe de Assis Ribeiro , Bahia, Thais Pimentel de Sa , Dias, Bruno Santos de Barros
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade do Estado do Rio de Janeiro
• Programa de Pós-Graduação: Programa de Pós-Graduação em Odontologia
• Departamento: Centro Biomédico::Faculdade de Odontologia
• País: Brasil
• Palavras-chave em Português: Má Oclusão Classe III de Angle; Imageamento Tridimensional; Cirurgia Ortognática; Aparelhos Ortodônticos Removíveis
• Palavras-chave em Inglês: Angle Class III Malocclusion; Three-Dimensional Imaging; Orthognathic Surgery; Removable Orthodontic Appliances
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::ODONTOLOGIA::ORTODONTIA
• Link de acesso: http://www.bdtd.uerj.br/handle/1/25942

This dissertation consists of two articles: a prospective controlled clinical trial that addresses the main purpose of this study, and a tutorial that details the three-dimensional (3D) evaluation methodology used in the clinical trial. The protocol was approved by the Ethics Committee (UERJ). The tutorial aimed to provide a guide for performing 3D tomographic analyses using a free software, describing the residual mandibular growth of a patient who underwent early orthognathic surgery first approach (SFA). The clinical study aimed to evaluate whether the use of clear aligners (CA) (Invisalign® system) affects the accuracy of virtual surgical planning (VSP) in patients undergoing SFA compared to patients undergoing the same surgical procedure but with fixed appliances (FA). Fourteen patients (7 in each group) with class III malocclusion and a mean age of 23 years were included. Cone beam computed tomography (CBCT) scans were taken before (T0) and one month after surgery (T1). The methodology was performed by comparing the displacement of overlapping three-dimensional models of the maxilla and mandible in the 'x', 'y' and 'z' axes and calculating the root mean square difference (RMSD). Regions of interest were defined for sagittal analyses: the deepest point of the premaxillary contour (point A), the deepest point of the mandibular alveolar process contour (point B); and for transverse analyses: points on the jugal process curve at the intersection of the right and left maxillary tuberosity contours (J'R and J'L), and the midpoint between the most posterior and inferior points of the right and left mandibular angle (Go'R and Go'L). Considering the clinically acceptable discrepancy limit of 2 mm in both groups, no mean difference was found in the three axes for each region. The CA group had a non-significant RMSD for the maxillary regions at points A (0.98 mm ± 0.96), J'R (0.68 mm ± 0.66), J'L (1 mm ± 0.56) and for the mandibular regions at points B (1.38 mm ± 0.72), Go'R (0.97 mm ± 0.60) and Go'L (1.63 mm ± 0.79). The FA group had a non-significant RMSD at points A (1.13 mm ± 0.87), J'R (0.63 mm ± 0.61), J'L (1.63 mm ± 0.79) and at points B (1.27 mm ± 0.71), Go'R (0.98 mm ± 0.51) and Go'L (0.62 mm ± 0.58). Accuracy when comparing the two groups showed no significant differences for RMSD at points A (p=0.73), J'R (p=0.91) and J'L (p=0.11) as well as at points B (p=0.79), Go'R (p=0.97) and Go'L (p=0.24). In conclusion, the use of CA does not compromise the accuracy of VSP in determining the sagittal and transversal position of the maxillary and mandibular segments in patients undergoing SFA.