Revista de Odontologia da UNESP
ISSN 1807-2577 (Eletrônico)
Artigo Original

Análise do perfil facial esquelético e de tecidos moles pré e pós-cirurgia ortognática em pacientes Classe II e III, e sua relação com a proporção áurea

Analysis of the skeletal and soft-tissue profiles pre and post orthognathic surgery in Class II and III patients and its relation with the golden proportion

Leticia Ângelo WALEWSKI, Elen de Souza TOLENTINO, Wilton Mitsunari TAKESHITA, Mariliani Chicarelli da SILVA

Resumo

Introdução: A proporção áurea, representada pela razão matemática 1:1.618, tem sido investigada na especialidade Ortodontia e no procedimento de Cirurgia Ortognática, a fim de ser estabelecida como um guia de sucesso clínico relacionado à estética facial. Objetivo: Verificar a estética dos perfis faciais de pacientes Classes II e III de Angle, antes e após tratamento ortodôntico-cirúrgico, além de correlacionar 13 razões dentoesqueléticas e cinco razões de tecidos moles à proporção áurea. Material e método: Um total de 94 radiografias cefalométricas laterais foram analisadas, em que 13 razões dentoesqueléticas e cinco razões em tecidos moles foram medidas e comparadas ao número áureo. Adicionalmente, uma análise subjetiva da estética facial pré e pós-tratamento foi realizada por 270 examinadores. Resultado: As razões dentoesqueléticas 1, 3, 6, 7, 8 e 9 aproximaram-se do número áureo após a cirurgia ortognática, nos pacientes Classe III. Para o perfil mole, apenas a razão 4 se aproximou ao número áureo, em ambos os pacientes Classe II e III. Em relação à avaliação subjetiva da estética, 91,49% dos perfis faciais foram considerados mais harmônicos após o tratamento. Conclusão: Frente à metodologia usada, pode-se concluir que a proporção áurea exerce pouca influência na avaliação da estética facial, não servindo como um guia para o planejamento e o tratamento ortodôntico-ortognático.

Palavras-chave

Estética; face; cirurgia ortognática; má oclusão de Angle Classe II; má oclusão de Angle Classe III.

Abstract

Introduction: The golden proportion, represented by the mathematical ratio 1:1.618, has been investigated in Orthodontics and orthognathic surgery in order to be established as a guide to clinical success related to facial aesthetics. Objective: To verify the facial aesthetics of patients with Angle Class II and III deformities pre and post orthodontic-surgical treatment, and to analyze if 13 dental-skeletal patters (ratios) and 5 soft tissue ratios moved closer to or further away from the golden proportion after the orthognathic surgery. Material and method: A total of 94 lateral cephalometric radiographs, in which 13 dental-skeletal ratios and 5 soft tissue ratios were measured and compared to the golden number. In addition, 270 examiners performed a subjective analysis of facial esthetics before and after treatment. Result: Dental-skeletal ratios 1, 3, 6, 7, 8 and 9 moved closer to the golden number after orthognathic surgery in Class III patients. For the soft tissue profile, only ratio 4 moved closer to the golden number in both Class II and III patients. Regarding the subjective evaluation of facial aesthetics, 91.49% of the facial profiles were considered more harmonic after treatment. Conclusion: Considering the methodology, it may be concluded that the golden proportion had little effect on the facial aesthetics evaluation and should not work as a guide for orthodontic-orthognathic planning and treatment.

Keywords

Aesthetics; face; orthognathic surgery; Angle class II malocclusion; Angle Class III malocclusion

Referências

1. Sant’Ana E, Kuriki EU, Arnett W, Lautenschläger GAC, Yaedu RYF. Avaliação comparativa do padrão de normalidade do perfil facial em pacientes brasileiros leucodermas e em norte-Americanos. Rev Dent Press Ortodon Ortop Facial. 2009 Fev;14(1):80-9. http://dx.doi.org/10.1590/S1415-54192009000100007.

2. Habbema L. Facial esthetics and patient selection. Clin Dermatol. 2004 Jan-Feb;22(1):14-7. PMid:15158539. http://dx.doi.org/10.1016/j.clindermatol.2003.12.032.

3. Ricketts RM. The biologic significance of the divine proportion and Fibonacci series. Am J Orthod. 1982 May;81(5):351-70. PMid:6960724. http://dx.doi.org/10.1016/0002-9416(82)90073-2.

4. Kiekens RM, Kuijpers-Jagtman AM, van ’t Hof MA, van ’t Hof BE, Maltha JC. Putative golden proportions as predictors of facial esthetics in adolescents. Am J Orthod Dentofacial Orthop. 2008 Oct;134(4):480-3. PMid:18929264. http://dx.doi.org/10.1016/j.ajodo.2006.10.041.

5. Mahshid M, Khoshvaghti A, Varshosaz M, Vallaei N. Evaluation of “golden proportion” in individuals with an esthetic smile. J Esthet Restor Dent. 2004;16(3):185-92, discussion 193. PMid:15597640. http://dx.doi.org/10.1111/j.1708-8240.2004.tb00032.x.

6. Jahanbin A, Poosti M, Salari S, Esmaily H, Sagha H. Effect of changes in divine proportion on esthetic perception of smile in frontal view. J Craniofac Surg. 2013 Nov;24(6):1946-9. PMid:24220379. http://dx.doi.org/10.1097/SCS.0b013e31829a8607.

7. Sunilkumar LN, Jadhav KS, Nazirkar G, Singh S, Nagmode PS, Ali FM. Assessment of facial golden proportions among North Maharashtrian Population. J Int Oral Health. 2013 Jun;5(3):48-54. PMid:24155602.

8. Naini FB, MossJP, Gill DS. The enigma of facial beauty: esthetics, proportions, deformity, and controversy.Am J Orthod Dentofacial Orthop. 2006 Sep;130(3):277-82. PMid:16979484. http://dx.doi.org/10.1016/j.ajodo.2005.09.027.

9. Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning-- part II. Am J Orthod Dentofacial Orthop. 1993 May;103(5):395-411. PMid:8480709. http://dx.doi.org/10.1016/S0889-5406(05)81791-3.

10. Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning. Part I. Am J Orthod Dentofacial Orthop. 1993 Apr;103(4):299-312. PMid:8480695. http://dx.doi.org/10.1016/0889-5406(93)70010-L.

11. Jefferson Y. Facial beauty-establishing a universal standard. Int J Orthod Milwaukee. 2004;15(1):9-22. PMid:15085778.

12. Silva MAS, Médici Filho E, Castilho JCM, Gil CTLA. Assessment of divine proportion in the cranial structure of individuals with Angle Class II malocclusion on lateral cephalograms. Dental Press J Orthod. 2012 Jun;17(3):88-97. http://dx.doi.org/10.1590/S2176-94512012000300018.

13. Ricketts RM. Divine proportion in facial esthetics. Clin Plast Surg. 1982 Oct;9(4):401-22. PMid:7172592.

14. Ferring V, Pancherz H. Divine proportions in the growing face. Am J Orthod Dentofacial Orthop. 2008 Oct;134(4):472-9. PMid:18929263. http://dx.doi.org/10.1016/j.ajodo.2007.03.027.

15. Pancherz H, Knapp V, Erbe C, Heiss AM. Divine proportions in attractive and nonattractive faces. World J Orthod. 2010;11(1):27-36. PMid:20209174.

16. Baker BW, Woods MG. The role of the divine proportion in the esthetic improvement of patients undergoing combined orthodontic/orthognathic surgical treatment. Int J Adult Orthodon Orthognath Surg. 2001;16(2):108-20. PMid:11482289.

17. Al-Marzok MI, Majeed KRA, Ibrahim IK. Evaluation of maxillary anterior teeth and their relation to the golden proportion in Malaysian population. BMC Oral Health. 2013;13(2):9. PMid:23347800. http://dx.doi.org/10.1186/1472-6831-13-9.

18. Sinko K, Jagsch R, Benes B, Millesi G, Fischmeister F, Ewers R. Facial aesthetics and the assignment of personality traits before and after orthognathic surgery. Int J Oral Maxillofac Surg. 2012 Apr;41(4):469-76. PMid:22129999. http://dx.doi.org/10.1016/j.ijom.2011.10.026.

19. Tatarunaite E, Playle R, Hood K, Shaw W, Richmond S. Facial attractiveness: a longitudinal study. Am J Orthod Dentofacial Orthop. 2005 Jun;127(6):676-82, quiz 755. PMid:15953892. http://dx.doi.org/10.1016/j.ajodo.2004.01.029.

20. Bragatto FP, Chicarelli M, Kasuya AV, Takeshita WM, Iwaki-Filho L, Iwaki LC. Golden proportion analysis of dental-skeletal patterns of Class II and III patients pre and postorthodontic-orthognathic treatment. J Contemp Dent Pract. 2016 Sep;17(9):728-33. PMid:27733715. http://dx.doi.org/10.5005/jp-journals-10024-1920.

21. Brum CVA, Saltori FA, Silva MCP, Pereira AC, Cunha FL, Paranhos LR. Estudo da proporção áurea em pacientes jovens Classe II, divisão 1 tratados ortodonticamente. Odonto. 2010;18(35):70-80. http://dx.doi.org/10.15603/2176-1000/odonto.v18n35p70-80.

22. Araújo MM, PasseriILA, AraújoA. Análise cefalométrica pré e pós-operatória das proporções divinas de Fibonacci em pacientes submetidos a avanço mandibular. Rev Dent Press Ortodon Ortop Facial. 2001;6(6):29-36.

23. Shell TL, Woods MG. Facial aesthetics and the divine proportion: a comparison of surgical and non-surgical Class II treatment.Aust Orthod J. 2004 Nov;20(2):51-63. PMid:16429875.

24. Garbin AJI, Passeri LA. Análise de proporções divinas em pacientes submetidos à cirurgia de retroposicionamento mandibular. Ortodontia. 2001 Maio-Ago;34(2):45-56.

25. Rupesh S, Rakesh S, Winnier JJ, Kaimal A, John A, Prasannan M, et al. The role of divine proportion in the perception of beauty: A cross sectional study. Amrita J Med. 2014 Jan-Jun;10(1):22-7.

59f85a700e8825965c967cb3 rou Articles
Links & Downloads

Rev. odontol. UNESP

Share this page
Page Sections