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Influência do padrão de extrações no tratamento de classes II na erupção do terceiro molar
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Introdução e objetivos: O estudo da relação entre o tipo de tratamento, com ou sem extrações de pré-molares, e o eixo de erupção dos terceiros molares é de extrema importância no estabelecimento do plano de tratamento ortodôntico. Este estudo retrospetivo tem como objetivos avaliar as alterações angulares dos terceiros molares e espaço retromolar disponível, através de ortopantomografias, bem como avaliar a taxa de inclusão e identificar fatores preditivos da mesma, em indivíduos com maloclusão de classe II tratados com e sem exodontia de pré-molares. Materiais e métodos: A amostra foi selecionada a partir registos de pacientes com maloclusão da classe II sujeitos a terapia ortodôntica com e sem extrações de pré-molares numa unidade privada de ortodontia em Lisboa. Após a aplicação dos critérios de inclusão e exclusão obteve-se uma amostra de 89 indivíduos que foram divididos em 3 grupos: o grupo SEM (tratamento sem exodontias) e o grupo EXO 4 (tratamento com exodontias de primeiros pré-molares superiores) e grupo EXO 4/5 (tratamento com exodontias de primeiros pré-molares superiores e segundos pré-molares inferiores). Foram analisadas duas ortopantomografias de cada indivíduo do pré e pós-tratamento, onde foram medidas duas variáveis angulares e uma variável linear, no maxilar superior e na mandíbula. Foi registada a decisão clínica de exodontia dos terceiros molares. Foi executada a estatística comparativa das variáveis dependentes através de testes T-Student e a estatística analítica através do teste Qui-quadrado. Resultados e conclusão: De uma forma geral, o tratamento ortodôntico favorece a angulação do terceiro molar superior e inferior e aumenta o espaço retromolar nos três grupos, ainda que não se verifique diferença estatisticamente significativa em todas as variáveis. No maxilar superior, existe um aumento significativo do ângulo entre o eixo longitudinal do terceiro molar e o plano oclusal e da distância retromolar, no grupo EXO 4. Na mandíbula, verifica-se um aumento significativo da distância retromolar, no grupo EXO 4/5. Estes valores são fatores preditivos favoráveis da erupção dos terceiros molares após o tratamento. A exodontia de pré-molares aumenta significativamente a probabilidade de erupção dos terceiros molares, mas não a garante, dependendo esta de outros fatores alheios ao tratamento ortodôntico, como a angulação inicial do terceiro molar e a distância retromolar inicial.
Introduction: The study of the relation between the type of treatment, with or without extractions of premolars, and the third molar eruption axis is extremely important in the establishment of the orthodontic treatment plan. This retrospective study aims to evaluate third molar angular changes and available retromolar space through panoramic radiographs, as well as to evaluate the inclusion rate and to identify predictive factors of it, in individuals with class II malocclusion treated with and without premolars extractions. Materials and methods: The sample was selected from records of class II malocclusion patients who were submitted to orthodontic therapy with and without extractions of premolars at a private orthodontic clinic in Lisbon. After applying the inclusion and exclusion criteria, a sample of 89 individuals were divided into 3 groups: the SEM group (no extraction treatment), the EXO 4 group (first maxillary premolars extraction treatment) and EXO 4/5 group (first maxillary premolars and second mandibular premolars extraction treatment). Two panoramic radiographs of the pre and posttreatment of each individual were analyzed, where two angular variables and one linear variable were measured in the maxilla and mandible. The clinical decision on third molar extraction was recorded. The comparative statistics of the dependent variables were performed through T- Student's tests and the analytical statistics using the Chi-square test. Results and conclusion: In general, orthodontic treatment benefits the upper and lower third molar angulations and increases the retromolar space in the three groups, although there is no statistically significant difference in all variables. On the maxilla, there is a significant increase in the angle between the third molar longitudinal axis and the occlusal plane and the retromolar distance in the EXO 4 group. In the mandible, there is a significant increase in the retromolar distance in the EXO group 4/5. These values are favorable predictive factors of the third molar eruption after orthodontic treatment. Premolars extraction significantly increases the probability of third molars eruption, but doesn’t guarantee it, depending on other factors unrelated to orthodontic treatment, such as the initial angle of the third molar and the initial retromolar distance.
Introduction: The study of the relation between the type of treatment, with or without extractions of premolars, and the third molar eruption axis is extremely important in the establishment of the orthodontic treatment plan. This retrospective study aims to evaluate third molar angular changes and available retromolar space through panoramic radiographs, as well as to evaluate the inclusion rate and to identify predictive factors of it, in individuals with class II malocclusion treated with and without premolars extractions. Materials and methods: The sample was selected from records of class II malocclusion patients who were submitted to orthodontic therapy with and without extractions of premolars at a private orthodontic clinic in Lisbon. After applying the inclusion and exclusion criteria, a sample of 89 individuals were divided into 3 groups: the SEM group (no extraction treatment), the EXO 4 group (first maxillary premolars extraction treatment) and EXO 4/5 group (first maxillary premolars and second mandibular premolars extraction treatment). Two panoramic radiographs of the pre and posttreatment of each individual were analyzed, where two angular variables and one linear variable were measured in the maxilla and mandible. The clinical decision on third molar extraction was recorded. The comparative statistics of the dependent variables were performed through T- Student's tests and the analytical statistics using the Chi-square test. Results and conclusion: In general, orthodontic treatment benefits the upper and lower third molar angulations and increases the retromolar space in the three groups, although there is no statistically significant difference in all variables. On the maxilla, there is a significant increase in the angle between the third molar longitudinal axis and the occlusal plane and the retromolar distance in the EXO 4 group. In the mandible, there is a significant increase in the retromolar distance in the EXO group 4/5. These values are favorable predictive factors of the third molar eruption after orthodontic treatment. Premolars extraction significantly increases the probability of third molars eruption, but doesn’t guarantee it, depending on other factors unrelated to orthodontic treatment, such as the initial angle of the third molar and the initial retromolar distance.
Descrição
Tese de mestrado, Medicina Dentária, Universidade de Lisboa, Faculdade de Medicina Dentária, 2018
Palavras-chave
Tratamento ortodôntico Terceiros molares Extração de dentes Teses de mestrado - 2018